Nodular vasculitis is a form of lobular panniculitis with multiple etiologies. It presents with tender erythematous or violaceous nodules and/or plaques, usually on the calves. Ulceration and drainage may occur. Lesions tend to heal with scarring and are prone to recurrence. Women are most commonly affected (80%-90% of patients), with peaks in incidence during early adolescence and around menopause.
There are many etiologies. Idiopathic nodular vasculitis may be seen on the calves of women in middle age who have varicosities. Mycobacterium tuberculosis infection is one of the strongest associated triggers. The term erythema induratum (of Bazin) refers specifically to cases of nodular vasculitis associated with underlying tuberculosis. Cases can also be induced by infectious agents such as Nocardia, Pseudomonas, Chlamydia, or hepatitis B or hepatitis C infections. Drugs may also be causative agents, with tumor necrosis factor (TNF)-alpha inhibitors, notably etanercept, implicated in case reports. The condition is thought to be either an immune complex-mediated vasculitis or a type IV cell-mediated response to an antigenic stimulus.
Related topic: cutaneous tuberculosis
Nodular vasculitis
Alerts and Notices
Synopsis
Codes
ICD10CM:
L95.8 – Other vasculitis limited to the skin
SNOMEDCT:
55275006 – Nodular vasculitis
L95.8 – Other vasculitis limited to the skin
SNOMEDCT:
55275006 – Nodular vasculitis
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Diagnostic Pearls
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Differential Diagnosis & Pitfalls
- Erythema nodosum is usually found on the anterior lower legs instead of posterior, is more septal, is usually less granulomatous, and is usually without vasculitis.
- Other types of infection-induced panniculitis tend to demonstrate more prominent neutrophils. Organisms may be identified with special stains and cultures.
- Furuncle
- Carbuncle
- Polyarteritis nodosa
- Thrombophlebitis
- Perniosis, also known as pernio and chilblains, occurs primarily on acral sites, with erythematous or violaceous macules, plaques, nodules, or ulcers, and is associated with cold exposure. Histologically, perivascular and often perieccrine lymphocytes, dermal edema, edema of vessel walls, and sometimes thrombi are seen.
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Management Pearls
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Therapy
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Drug Reaction Data
Below is a list of drugs with literature evidence indicating an adverse association with this diagnosis. The list is continually updated through ongoing research and new medication approvals. Click on Citations to sort by number of citations or click on Medication to sort the medications alphabetically.
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References
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Last Reviewed:08/15/2022
Last Updated:08/29/2022
Last Updated:08/29/2022
Nodular vasculitis