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Building Blocks of Dermatopathology

BAD DermpathPRO Learning Hub: Diagnostic Clues

Diagnostic Challenge
Interesting Case

Case Number : CT0017 Dr. Hafeez Diwan

Please read the clinical history and view the images by clicking on them before you proffer your diagnosis.
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36 years-old HIV positive female, 35 weeks pregnant with urticarial rash on trunk and bilateral upper and lower extremities. Clinical impression: Pruritic urticarial plaques of pregnancy.

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Guest Dr Engin Sezer - Urticarial vasculitis

Guest - Agree urticarial vasculitis
Guest Bansal - Urticarial vasculitis

Guest Romualdo C. L. Filho - Neutrophilic small-vessel vasculitis. I could not see fibrin deposits in the vessel walls. I think they would be expected in a leukocytoclastic vasculitis, including an urticarial vasculitis, with such a large quantity of neutrophils. I favor an infectious vasculitis and would order special stains and cultures.

Guest Rodrigo Restrepo - Urticarial vasculitis
Robledo F. Rocha - I agree with urticarial vasculitis. Infiltrate is too sparse and there’s only mild vascular injury.

Guest Jim Davie MD - The venule infiltration by numerous neutrophils (and sparse eosinophils) in the superficial dermis is in stark contrast to the surrounding dermis that shows minimal infiltrate. The 1st low-power image has a tightly cuffed perivascular dermatitis (superficial and deep) that seems to spare the thick-walled arterioles, and variably affect the other vessels; there is negligible interstitial infiltrate, negligible edema, and no significant epidermal changes (? early parakeratosis development). I would lean towards the clinical impression of PUPPP.

Dr. Mona Abdel-Halim - I think the walls of the blood vessels are infiltrated with neutrophils, some fenestration of he collagen (edema), prefer urticarial vasculitis. In PUPP, lymphocytic vasculitis is present.
Dr. Hafeez Diwan - I called this urticarial vasculitis.
IgorSC - Leukocytoclastic vasculitis, could be Urticarial vasculitis.

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