Case Number : Case 76 Posted By: Guest

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

This was a very difficult case today. The closest diagnosis was lepromatous leprosy. I included the case to remind you that when you see foamy histiocyte-like cells with scattered lymphocytes and an occasional plasma cell not to foget the atypical mycobacterial infections. The case is an example of mycobacterium avium intracellulare.

Submitted on 23/09/2010 20:53
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Lushen Pillay - Wits Dermatology, South Africa (South Africa) Wrote:

Can only think of syphilis at this stage.

Submitted on 23/09/2010 19:45
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Mona Abdel-Halim - Dermatology Department, Faculty of Medicine, Cairo University (Egypt) Wrote:

Seems that all are favouring an infection today. Syphilis with ? end arteritis obliterans sounds a nice idea but stii I believe that I can c vacuoles in the cytoplasm of the endothelial cells???

Submitted on 23/09/2010 19:01
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Marcela Saeb Lima - MSLDermatopato (Mexico City) Wrote:

I go for shyphilis

Submitted on 23/09/2010 17:38
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Eman El-Nabarawy - Cairo University (Egypt) Wrote:

Leprosy in reaction.

Submitted on 23/09/2010 16:35
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ATJ - UK () Wrote:

Syphilis

Submitted on 23/09/2010 16:29
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Donald McVey - (UK) Wrote:

Interesting case - I think Lepromatous Leprosy

Submitted on 23/09/2010 16:28
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Carlos Mee - (USA) Wrote:

I am not sure about this - granulomatous inflammation with plasma cells ? Syphilis

Submitted on 23/09/2010 16:27
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Juan Carlos Garcés - Hospital Oncológico / Hospital Luis Vernaza (Guayaquil Ecuador) Wrote:

Good morning every one... My first impresion Lepromatous Leprosy. Although there are vessels with prominent endothelium and eritrocytes extravasacion, denoting some vascular injury, so I think in the possibility of Granuloma faciale or syphilis

Submitted on 23/09/2010 14:35
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Saleem Taibjee - Warwick () Wrote:

Finding this quite tricky. I feel that there is a rather dirty grey quality here suggestion an infectious process. I have considered leprosy and syphilis, and also Malakoplakia, bacillary angiomatosis. I can't see any definite amastigotes to suggest Leish.

Submitted on 23/09/2010 13:48
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Mona Abdel-Halim - Dermatology Department, Faculty of medicine, Cairo University (Egypt) Wrote:

This is a very difficult case. I percieved something else. The structures on the left side look to me like 2 clumps of cells with small lumina. The cells are large with large nuclei and abundant esinophilic cytoplasm. I am not sure, but I think there are also some cytoplasmic vacuoles in these cells. They are surrounded by lymphocytic infiltrate which is also visible in the stroma. Thought of angiolymphoid hyperplasia, but can not see the esinophils to say angiolymphoid hyperplasia with esinophilia, may be somewhere else in the field. Looking at the right side, I can see some bizzare cells, together with the stromal extravasated RBC's, I thought of Symplastic hemangioma. Very difficult!!!

Submitted on 23/09/2010 13:10
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Miguel Sanz - UAH (Spain) Wrote:

One plasma cell = inflamation, two plasma cells = syphilis, more plasma cells = myeloma / plasmacytoma. Yes there are only two plasma cell and I bet also for infectious aetiology but Mycobacterium leprae instead Treponema pallidum. The cytoplasm of histiocytes is very peculiar and there are not some histiocytes, I see an infiltrate predominantly histiocytic.

Submitted on 23/09/2010 08:54
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Marwa Fawzi - Dermatology Department, Faculty of Medicine, Cairo University (Egypt) Wrote:

I can see a perivascular infilterate which is predominantly lymphocytic,with some histiocytes and a small amount of plasma cells so my provisional diagnosis is 2 ny syphilis.

Submitted on 23/09/2010 05:04
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