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In this section we have spot diagnoses posted on a daily basis since June 2010, now over 4000! You can review the archived cases and read the suggested diagnoses by users and the final comment by the contributors.
Case are uploaded each week day by 10 am UK time with the correct diagnosis will generally be posted at 8 pm UK time. Why not view the most recent spot diagnosis and proffer a diagnosis?

Case Number : Case 647 - 30 Nov Posted By: Guest

Please read the clinical history and view the images by clicking on them before you proffer your diagnosis.
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Male 33 years with widespread papules.
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Go to records November 2012

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Guest Hazem Hamed

Guest Hazem Hamed

Posted

Non necrotizing granulomatous inflammation due to blastomycosis. Is there a history of immunosuppression eg HIV,........?

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Guest Robledo F. Rocha

Guest Robledo F. Rocha

Posted

It’s a systemic mycosis, favouring North American blastomycosis. There is dermal suppurative granulomatous inflammation. PAS stain shows budding yeast forms within giant cells. Although the disseminated cutaneous lesions suggest opportunistic infection, this fungal infection preferentially does not develop in immunosuppressed patients.

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Arif Usmani

Arif Usmani 17

Posted

Broad based-budding. Favor North American Blastomycosis

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Arif Usmani

Arif Usmani 17

Posted

There should be pseudoepitheliomatous hyperplasia which I do not see unless it is a primary innoculation but history suggests a disseminanted infection.

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Dr. Phillip McKee

Dr. Phillip McKee 130

Posted

I agree that Fig 3 resembles blastomycosis although a nucleus is not visible. Against blastomycosis, the PAS shows narrow-based-budding similar to cryptococcus. Blastomycosis shows broad based budding and in the examples that I have seen, chains are absent. Unfortunately cultures were negative in this case. Many thanks for your comments this week. Have a great weekend.

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Sasi Attili

Sasi Attili 85

Posted

[quote name='Dr. Phillip McKee' timestamp='1354302392']
I agree that Fig 3 resembles blastomycosis although a nucleus is not visible. Against blastomycosis, the PAS shows narrow-based-budding similar to cryptococcus. Blastomycosis shows broad based budding and in the examples that I have seen, chains are absent. Unfortunately cultures were negative in this case. Many thanks for your comments this week. Have a great weekend.
[/quote]
I am confused Dr.Mckee. So are you saying that this is cryptococcus?

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