Erythema induratum in a Kenyan child

Area of Science:

• Dermatology
• Pediatrics
• Infectious Diseases

Background:

• Tuberculosis (TB) can present with diverse extrapulmonary manifestations.
• Erythema induratum (EI) is a rare form of panniculitis often associated with TB.

Observation:

• A 10-year-old girl presented with painful skin nodules, constitutional symptoms, and a persistent cough.
• Initial investigations showed a positive Mantoux test, non-specific chest X-ray findings, and negative bacteriology for Mycobacterium tuberculosis.
• Skin biopsy revealed granulomatous panniculitis consistent with EI.

Findings:

• Despite negative initial bacteriology and non-specific chest X-ray, the clinical presentation led to a diagnosis of pulmonary tuberculosis.
• The patient responded well to a standard 6-month anti-tuberculosis regimen (isoniazid, rifampicin, pyrazinamide).

Implications:

• This case highlights the importance of considering tuberculosis in pediatric patients with unexplained skin lesions and systemic symptoms, even with atypical diagnostic findings.
• Prompt initiation of anti-tuberculosis therapy can effectively manage both cutaneous and pulmonary manifestations.