Program-wide review and follow-up of erythema Induratum of Bazin and tuberculosis-associated ocular inflammation management in a TB low-incidence setting: need for improved treatment candidate selection, therapy standardization, and care collaboration

BMC Infect Dis. 2019 Jan 29;19(1):97. doi: 10.1186/s12879-019-3737-5.


Background: Erythema induratum of Bazin (EIB) - nodular vasculitis associated with Mycobacterium tuberculosis (TB) - and Tuberculosis-Associated Ocular Inflammation (TB-AOI) represent uncommon manifestations of TB. There is limited data and a lack of diagnostic and treatment standards for these conditions.

Methods: Eleven-year retrospective review of EIB and TB-AOI cases managed in a provincial TB program with prospective phone-based follow-up of anti-tubercular therapy (ATT) recipients. Presumptive TB-AOI and EIB diagnoses were determined by ophthalmologist or dermatologist assessments correlated with positive tuberculin skin test and/or QuantiFERON-TB Gold, along with pathologic criteria in EIB cases.

Results: Of 21 EIB and 20 TB-AOI cases that received ATT, 13 and 11, respectively, were reached for follow-up. The majority of EIB and TB-AOI cases were female and immigrated from TB high-burden countries. Median durations of pre-diagnosis symptoms were 2 and 0.8 years (IQR 2.5 & 1.1) for EIB and TB-AOI cases, respectively. Overall, 14 different ATT regimens were used for a median duration of 6 months (range 5-9). ATT related adverse events resulting in treatment discontinuation occurred in 14% of EIB and 10% of TB-AOI cases. On last follow-up, 76% of EIB and 42% of TB-AOI had improvement or resolution of disease.

Conclusion: EIB and TB-AOI were uncommon presentations receiving variable therapy. While treatment response was modest for EIB cases, TB-AOI cases had sub-optimal treatment outcomes. The unique diagnostic and management challenges presented by these conditions in TB low-incidence settings highlight a need for improved treatment candidate selection, therapy standardization, and cross-specialty medical collaboration.

Keywords: Canada; Erythema induratum; Treatment outcome; Tuberculids; Tuberculosis; Tuberculosis-associated ocular inflammation; Uveitis.

MeSH terms

  • Adult
  • Antitubercular Agents / therapeutic use
  • Canada / epidemiology
  • Cooperative Behavior*
  • Erythema Induratum / complications
  • Erythema Induratum / epidemiology
  • Erythema Induratum / therapy*
  • Female
  • Follow-Up Studies
  • Health Services Needs and Demand
  • Humans
  • Incidence
  • Male
  • Middle Aged
  • Mycobacterium tuberculosis / physiology
  • Patient Care Team* / organization & administration
  • Patient Care Team* / standards
  • Patient Selection*
  • Quality Improvement / organization & administration
  • Quality Improvement / standards
  • Reference Standards
  • Retrospective Studies
  • Standard of Care / organization & administration
  • Standard of Care / standards*
  • Treatment Outcome
  • Tuberculosis, Ocular / complications
  • Tuberculosis, Ocular / epidemiology
  • Tuberculosis, Ocular / therapy*
  • Young Adult


  • Antitubercular Agents