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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 829 - 21st August Posted By: Guest

Please read the clinical history and view the images by clicking on them before you proffer your diagnosis.
Submitted Date :
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77-year-old female with leg lesions.


Case posted by Dr. Hafeez Diwan.


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Guest Maria George

Posted

This is a case of pigmented purpura.

[url="/wiki/Schamberg%27s_disease"]There are types listed below but some people like to lumb it together.[/url]
[url="/wiki/Schamberg%27s_disease"] Schamberg's disease[/url][list]
[*][url="/wiki/Majocchi%27s_disease"]Majocchi's disease[/url] (Purpura annularis telangiectodes)
[*][url="/wiki/Gougerot-Blum_syndrome"]Gougerot-Blum syndrome[/url] (Pigmented purpuric lichenoid dermatitis)
[*][url="/wiki/Ducas_and_Kapetanakis_pigmented_purpura"]Ducas and Kapetanakis pigmented purpura[/url]
[*][url="/wiki/Lichen_aureus"]Lichen aureus[/url]
[/list]

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Wolter Mooi

Posted

I would agree with Maria. Large numbers of extravascular erythrocytes; pigment in cells with morphologic features compatible with histiocytes; pronounced inflammatory response (usually - though not always - absent in case of multiple melanoma in transit metastases). So, my vote goes to pigmented purpura.

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Guest Yüksel OKUMUŞ, MD

Posted

Agree with pigmented purpuric dermatoses. Altough there is no epidermotropism, needs investigation for T- cell lenfoproliferative disorders.

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It has all the elements for a Pigmented purpuric dermatitis. The different clinical types will depend on the clinical findings, like the extend and number of the lesions, pruritus, age, etc.
I think there is no vascular proliferation or stasis alterations for an Acroangiodermatitis and the pigments are haemossiderin, not melanin.

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Guest Saleem Taibjee

Posted

Agree PPD. Can't see any MF features here.

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Guest Romualdo

Posted

I must admit: Maria an all the others are correct! The pigmented cells are histiocytes and the diagnosis pigmented purpuric dermatitis! I think I was still sleeping!

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Arti Bakshi

Posted

Agree with pigmented purpuric dermatosis.
I thought there was a vaguely granulomatous look to the infiltrate, and I wonder if this would fit with the rare 'granulomatous variant of PPD'.

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Guest Graham Reilly

Posted

PPD - Erythrocyte extravasation with histiocytes and haemosiderin.

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Guest Tiberiu Tebeica

Posted

persistent pigmented purpuric dermatitis, Gougerot-Blum's lichenoid purpura if it fits clinically

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Robledo F. Rocha

Posted

Lichenoid purpura of Gougerot and Blum.

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Dr. Hafeez Diwan

Posted

Yes. I called this pigmented purpuric dermatosis. As expected, an iron stain highlighted the hemosiderophages.

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