Why you should ask your patients about their fishing hobbies

Patients who use immunosuppressive agents, in particular medication that blocks tumour necrosis factor-a, are at risk for mycobacterial infections. Besides the typical Mycobacterium tuberculosis infection, a lso a typical mycobacterial disease may occur. Here we demonstrate two patients with such atypical mycobacterial infection due to swimming and fishing water contact. We propose that patients, before starting with immunosuppressive therapy, are counselled about risk factors for mycobacterial disease.

Erythema induratum (Bazin's disease)

The clinical and histologic features of 26 cases of erythema induratum are reviewed. The characteristic cutaneous lesions on the legs of middle-aged women were violaceous, indurated nodules, 1 to 2 cm in diameter, which were painful, occasionally ulcerated, and could heal with scarring. The diagnosis was confirmed in all patients by a strongly positive Mantoux test result (1:10,000 dilution) and by clearing of lesions after antituberculosis therapy. The histologic features were varied but were predominantly those of a vasculitis with a paraseptal and lobular panniculitis. Although it was not possible to fulfill the required criteria for diagnosing tuberculosis in these lesions, we believe there is sufficient circumstantial evidence to support the hypothesis that erythema induratum is a true tuberculid.

[The current state of cutaneous tuberculosis]

Thirty-three years after the introduction of the chemotherapeutics and as result of massive prophylactic and preventive measures the tuberculosis of the skin shows a clear epidemiologic and clinical change. Nowadays the clinical picture of the tuberculosis of the skin restricts essentially to the classical forms of the lupous, verrucous and colliquative tubervulosis of the skin, the specific etiology and pathogenesis of which are ascertained. The so-called tuberculids should at present only be treated in a qualified sense in the chapter of tuberculosis of the skin. After a short description of the diagnostic possibilities and after a historical survey on former measures of treatment the present GDR standard in therapy is explained. The qualification for carrying on the isonicotinic acid hydrazide monotherapy in the tuberculosis cutis luposa and verrucosa is proved on the basis of bacteriological, pathologo-anatomical and clinical peculiarities of these forms of tuberculosis of the skin.