Case Number : case 62 Posted By: Guest

Phillip McKee - Overseas consultations (Arizona, USA) Wrote:

The final diagnosis is early erythema multiforme but you couldn't know that without the clinical information. Your differential diagnoses were excellent. Have a great weekend and see you all on Monday. Phillip

Submitted on 03/09/2010 21:48
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Marwa Fawzi - Cairo University (Cairo) Wrote:

I agree with all, but my first impression is early EM.

Submitted on 03/09/2010 18:34
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Wayne Grayson - (Johannesburg, South Africa) Wrote:

Lichenoid interface dermatitis, with a wide differential diagnosis to consider.

Submitted on 03/09/2010 16:07
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Juan Carlos Garcés - Hospital Oncológico / Hospital Luis Vernaza (Guayaquil Ecuador) Wrote:

there si nothing to add.. Interface dermatitis with abundant necrotic keratinocytes.. Erythema multiforme, PLEVA, among others.. You are so lucky Dr. Carr..

Submitted on 03/09/2010 15:38
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Phillip McKee - Overseas consultations (Arizona, USA) Wrote:

Good morning all. You are all quite correct. This case is very much one that requires clinicopathological correlation. I will give the final diagnosis later. Phillip

Submitted on 03/09/2010 15:00
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Richard Carr - Warwick Hospital (UK) Wrote:

Just enjoyed a pot pourri of all the cases I missed while holidaying in the Italian lakes. I think my favourites were the coccidiodomycosis and the maduralla closely followed by the lymphangiomatous KS. Regarding case 50 cutaneous macular (or lichenoid) amyloid. We usually diagnose it on H&E as here but to show it off for a meeting or to the clinical colleagues who don't believe you we do a pan-keratin cocktail and they show up brilliantly. Congo red is not usually very rewarding for these amyloid forming keratin deposits formed from colloid body aggregates that are derived from presumably apoptotic keratinocytes that have dropped down in to the papillary dermis.

Submitted on 03/09/2010 14:35
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Marcela Saeb Lima - MSLDermatopato (Mexico City) Wrote:

Interface dermatitis we certainly need the clinical setting, otherwise we will be guessing in a list from fixed drug eruption, PLC, syphilis, PR, lupus, etc... But lovely histology as usual!

Submitted on 03/09/2010 10:23
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Eman El-Nabarawy - Cairo University (Egypt) Wrote:

Agree with Dr Carr.

Submitted on 03/09/2010 10:21
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Mona Abdel-Halim - Dermatology Department, Faculty of Medicine, Cairo University (Egypt) Wrote:

I agree with Dr Carr that this is definitly a case for DDx. Lichenoid tissue reaction (vacuolar degeneration and apoptotic bodies) together with an infiltrate obscuring the DEJ (interface dermatitis). Stratum corneum is intact, I will consider early EM first and subacute LE first. Other possibilities: Fixed drug eruption and Lichenoid drug eruption (due to the presence of very few esinophils), PLC (few extravasated RBC'S), and to complete the DDx of lichenoid tissue reaction with interface infiltrate one should consider PNP and GVHD.

Submitted on 03/09/2010 09:40
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Richard Carr - SWH (Warwick, UK) Wrote:

This is a differential diagnosis case. Lichenoid & interface with numerous apoptotic keratinocytes mainly basally located. In rough order of likelihood: Subacute cutaneous Lupus; Lichenoid Drug eruption; erthema multiforme; GVHD; PLEVA; Paraneoplastic pemphigus; lichenoid Mycosis fungoides and even "lichenoid keratosis". Histology looks rather acute and I would plump for Lupus / Drug or early EM. Too much apoptosis for PLC would like a low power for PLEVA but only occasional extravasated RBC here. Some of the infiltrate looks histiocyte like and if there is prominent apopototic debris would also consier Kikuchi's. Nice to be back after my hols. Must look at all the wonderful cases I missed. Regards to all

Submitted on 03/09/2010 08:48
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Eman El-Nabarawy - Cairo University (Egypt) Wrote:

Pityriasis licenoids chronica.DD: pityriasis rosea.

Submitted on 03/09/2010 08:05