Ulcères des membres inferieurs de diagnostic difficile : un cas d'erythème indure de Bazin

Introduction : Bazin's disease is a lobular panniculitis associated to a vasculitis of the hypodermic vessels with ischemic lesions of the subcutaneous tissue, necrosis and inflammatory reaction of a granulomatous type. It presents with hypodermic plaques and erythematous nodules, of many various dimensions, with recurrent feature. The disease normally has a progressive evolution. Patient : A 79 year old woman come under our observation for the presence of multiple nodular lesions located in the anterolateral region of the inferior third of the leg, progressively ulcerating. An arterio-venous Duplex scan of the inferior limbs showed a bilateral modest incontinence of the great saphenous vein, not sufficient to justify the presence of the trophic lesions. A standard radiography of the thorax, showed the presence of tubercular results. A Mantoux test turned largely positive. The biopsy of one of the cutaneous lesions revealed a granulomatous dermic phlogosis, with a necrotic extension to the hypoderm. The diagnosis of the Bazin's disease was pronounced. Subsequently, the lesions evolved in a recovery thanks to an only local treatment, with an ulcering recurrence 10 months later. Even if such lesions are still present today, the patient never wanted to proceed to any antitubercular treatment. The utility of the antitubercular treatment in the Bazin's disease is moreover underlined unanimously in all the cases reported in Literature. Conclusions: The Bazin's disease is a rather rare pathology, but it has to be taken into account when in situation of treating ulcerate lesions for which vascular or rheumatologic etiology has been excluded. If a histologic exam combined to a possible complementary research confirms the Bazin diagnosis, the indication of executing an antitubercular therapy has to be thoughtfully considered.