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What is nodular vasculitis?
Nodular vasculitis is the commonest form of lobular panniculitis with vasculitis. It is
considered to be a ‘reactive disorder’, but, in many patients, no underlying trigger is
identified.

Bazin described this form of vasculitis in 1861, and a link with TB was recognized in the
early 1900s. TB is still the commonest infectious trigger, and Mycobacterium
tuberculosis DNA has been demonstrated in cutaneous biopsies.

Nodular vasculitis is commonest on the back of the legs of obese middle-aged women in
whom chronic venous stasis, previous thrombophlebitis, and/or cooling may play some
part in the localization to the leg. the condition tends to run a protracted course over
many years.

What should I look for?
• History of recurrent nodules that form slowly and equally slowly resolve.
• Tender, erythematous, indurated nodules and plaques on the calves (rather than the
shins) of fat legs where the skin is cyanotic and cold. Nodules develop most often in
winter months.
• Ulceration of nodules (unlike EN).
• Atrophic scars (depressions) where ulcerated nodules have healed.
• Venous insufficiency of the lower legs (a frequent association).
• Any indications in history and examination of an underlying disease such as TB.

What should I do?
• Take a deep incisional biopsy to demonstrate the pathology.
• Exclude TB by chest radiography, Mantoux test, and/or a TB IFN-γ release assay
(QuantiFERON® TB Gold test or T-SPOT® TB test).
• Treat the underlying disease, if identified.
• Control venous stasis by weight loss, compression bandages, elevation, and exercise.
• Relieve pain with NSAIDs.
• Corticosteroids are not usually indicated.

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