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In this section we have spot diagnoses posted on a daily basis since June 2010, now over 1700! You can review the archived cases and read the suggested diagnoses by users and the final comment by Dr Uma Sundram, the Editor-in-Chief and main spot diagnosis host. Case are uploaded each week day by 10 a.m. UK time with the correct diagnosis will generally be posted at 8 p.m. UK time. Why not view the most recent spot diagnosis and proffer a diagnosis?

Case Number : Case 818 - 6th August 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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34 years old white man, carries a diagnosis of non-Hodgkin's lymphoma, and has been on chemotherapy for 3 months. He has a 1-2 years history of "tight" skin and dysphagia.

Case posted by Dr. Mark Hurt.


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Arti Bakshi

Posted

[i]Agree[/i]
[i]Thickening of dermis with increased dermal mucin (appears to be more in deeper dermis), consistent with Scleredema.[/i]

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Guest Maria George

Posted

Increased fibroblast, mucin and fibrosis ends in a diagnosis of Sclermexedema which is associated with paraproteinemia.Patients usually have cardiac , neurologic and hematological complications like this patient who has lymphoma.

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Robledo F. Rocha

Posted

[font="Palatino Linotype, serif"][size="4"]Non-inflammatory dermal thickening characterized by morpheaform entrapment of eccrine sweat glands and fenestrations between sclerotic collagen bundles filled with abundant mucin deposits, highlighted by colloidal iron, in the absence of fibroblastic proliferation.[/size][/font]
[font="Palatino Linotype, serif"][size="4"]Given the case history, I would call this monoclonal gammopathy-associated scleredema.[/size][/font]

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Scleromyxedema should appear with increased fibroblasts and It also does not affects the tongue or the esophageal musculature, which could explain the dysphagic symptom. I don´t see increased fibroblasts.
I think this is a Scleredema of Buschke with its increased dermal thickness and mucin, no or few fibroblast proliferation and no inflammatory cells. Scleredema can also appear with dysphagic symptoms and can be secondary to malignant lymphoid diseases.

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Guest Rodrigo Restrepo

Posted

[color=#1C2837][font=arial, verdana, tahoma, sans-serif][size=4]Scleredema[/size][/font][/color]

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Guest Graham Reilly

Posted

Scleroedema - Thickened dermis,replacement of fat by coarse collagen bundles and mucin.I couldn`t see any fibroblast proliferation - are you supposed to see this in scleroedema?

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Dr. Mona Abdel-Halim

Posted

I do not perceive considerable fibroblast proliferation, so I also favor this to be scleredema.. Could be paraneoplastic.

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Sasi Attili

Posted

[quote name='Dr. Mona Abdel Halim' timestamp='1375793544']
I do not perceive considerable fibroblast proliferation, so I also favor this to be scleredema.. Could be paraneoplastic.
[/quote]
agree

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Guest Jim Davie MD

Posted

Scleredema.

The biopsy shows thickening of the reticular dermis (with illusion of an upwards displacement of eccrine coils from deep to mid-reticular dermis) and increased dermal mucin. No significant fibroblast increase is seen, which would be expected for the differential dx consideration of scleromyxedema.

I agree that the history of non-Hodgkin's lymphoma (with presumed absent history of infection or diabetes) and long history of sclerodermoid symptoms would favor monoclonal gammopathy as the likely cause of scleredema. Dysphagia can be seen in both scleredema and scleromyxedema.

Frequently, scleredema will present several years (median 2.5 years) before a monoclonal gammopathy can be detected by serum protein electrophoresis (SPEP) testing. A negative SPEP test therefore does not exclude gammopathy-related scleredema. (This delay may not apply to patients with previous lymphoma diagnosis).
Did this patient have a positive SPEP?

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Guest Romualdo

Posted

I agree with most of my colleagues: scleredema.

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Mark A. Hurt MD

Posted

My diagnosis was: Scleredema.

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