567. Erythema induratum and tuberculosis-associated ocular inflammation in low tuberculosis incidence setting: 11-year retrospective case review with prospective clinical follow-up in Alberta, Canada
Session: Poster Abstract Session: Tuberculosis Treatment and Outcome
Thursday, October 27, 2016
Room: Poster Hall
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  • Background: Erythema induratum (EI) – nodular vasculitis associated with Mycobacterium tuberculosis (TB) – and Tuberculosis-Associated Ocular Inflammation (TB-AOI) represent uncommon manifestations of TB in low incidence countries. Both entities are diagnosed indirectly and neither has standardized therapy.

    Methods: Retrospective review of EI and TB-AOI cases managed in a provincial TB program between January 1, 2004, and December 31, 2014. Prospective phone-based follow-up pursued for those who received anti-tuberculosis therapy (ATT). TB-AOI diagnosis was based on referring ophthalmologist’s assessment and positive TB testing (IGRA/TST). EI cases were referred following dermatologist assessment and met clinical or pathologic criteria along with positive TB testing.

    Results: 22 EI and 21 TB-AOI cases were managed over the study period, 10 and 11, respectively, were reached for phone-based follow-up. The majority of EI and TB-AOI cases were female and immigrated from TB high-burden countries. Mean ages at time of diagnosis were 44.3 and 39 years (IQR 8.25 & 18) for EI and TB-AOI cases, respectively. Mean duration of symptoms prior to diagnosis were 3.1 and 1.8 years (IQR 2 & 2.1) for EI and TB-AOI cases, respectively. Amongst 17 EI cases that underwent biopsy, granulomatous inflammation was the most common finding (88%) followed by panniculitis (59%), necrobiosis (53%) and vasculitis (47%). ATT was initiated in 41 (95%) cases with 36 (88%) completing therapy. 14 different ATT regimes were used for a mean duration of 5.8 months (Range 1-9). ATT related side effects occurred in 52% of EI and 35% of TB-AOI cases of which 18% and 19%, respectively, resulted in therapy cessation. Clinical resolution was documented in 70% of EI cases at a mean clinical follow-up of 7.3 months (Range 0-48); however, only 50% of EI and 18% of TB-AOI patients reported sustained resolution of symptoms on phone-based follow-up at mean post treatment periods of 4.5 and 3.8 years (IQR 3.8 & 4), respectively.

    Conclusion: In this cohort, EI and TB-AOI represented uncommon presentations receiving highly variable therapy with high rates of ATT side effects. Fewer than half of patients contacted on follow-up reported durable resolution of symptoms.

    William J. Connors, MD, Dina Fisher, MD and Julie M. Jarand, MD, Department of Medicine, University of Calgary, Calgary, AB, Canada


    W. J. Connors, None

    D. Fisher, None

    J. M. Jarand, None

    Findings in the abstracts are embargoed until 12:01 a.m. CDT, Wednesday Oct. 26th with the exception of research findings presented at the IDWeek press conferences.