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

• Published in: BMC infectious diseases Vol. 19; no. 1; p. 97
• Main Authors: Connors, William J, Fisher, Dina A, Kunimoto, Dennis Y, Jarand, Julie M
• Format: Journal Article
• Language: English
• Published: England BioMed Central Ltd 29.01.2019; BioMed Central; BMC
• Subjects: Analysis; BCG; Canada; Care and treatment; Diagnosis; Emigration and immigration; Erythema; Erythema induratum; Inflammation; Medical tests; Prevalence studies (Epidemiology); Skin; Treatment outcome; Tuberculids; Tuberculin; Tuberculosis; Tuberculosis-associated ocular inflammation; Uveitis; Vasculitis; Canada; Treatment outcome; Tuberculosis-associated ocular inflammation; Tuberculids; Tuberculosis; Erythema induratum; Uveitis
• ISSN: 1471-2334; 1471-2334
• DOI: 10.1186/s12879-019-3737-5

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. 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. 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. 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.