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April 1997

Detection of Mycobacterium tuberculosis DNA in Lobular Granulomatous Panniculitis (Erythema Induratum-Nodular Vasculitis)

Arch Dermatol. 1997;133(4):457-462. doi:10.1001/archderm.1997.03890400057008

Objective:  To determine, using polymerase chain reaction (PCR) amplification, if Mycobacterium tuberculosis complex DNA is present in the skin biopsy specimens of lobular granulomatous panniculitis.

Design:  A retrospective descriptive study.

Setting:  A university-based hospital.

Patients:  From the 65 patients included in the study, we examined 72 paraffin-embedded skin biopsy specimens with a histologic diagnosis of erythema induratum or nodular vasculitis. The biopsy specimens were from the histopathological archives of the Departments of Dermatology and Pathology of the Hospital de la Santa Creu i Sant Pau, Barcelona, Spain, from 1976 to 1994. Twenty-two biopsy specimens were excluded from the final analysis because we could not amplify the internal control.

Main Outcome Measures:  Detection of a 123—base pair fragment of the IS6110 insertion sequence specific for M tuberculosis complex.

Results:  The results of PCR amplification were positive for M tuberculosis complex DNA in 77% of the skin biopsy specimens. No significant difference could be detected with respect to the age of the patients, ulceration of the nodules, reactivity to purified protein derivative, abnormal results of a chest x-ray examination, personal and family history of tuberculosis, and PCR results. The presence and degree of necrosis on histologic examination were significantly higher in the PCR-positive group (P=.04). None of the following variables were associated with PCR results: presence of vasculitis, degree of granulomatous infiltrates, number of giant cells, and presence of well-organized granulomas.

Conclusions:  The DNA of M tuberculosis can be detected in a considerable number of skin biopsy specimens of lobular granulomatous panniculitis. None of the clinical and histologic variables evaluated could accurately predict the results of PCR amplification. Arch Dermatol. 1997;133:457-462