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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 792 - 1st July 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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65 years-old female with a shave biopsy of a verrucous plaque from the right index finger.

Case posted by Dr Mark Hurt.


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Guest Jim Davie MD

Posted

Fibrinoid necrosis (glassy eosinophilic changes of vessel walls) with neutrophil-predominant perivascular inflammatory infiltrate. Lesser numbers of eosinophils and lymphocytes. Verrucous epidermal hyperplasia with no significant epidermal inflammatory changes.
As an isolated finger lesion, infection, insect bite reaction, pyoderma gangrenosum, or (for something exotic) [url="http://archderm.jamanetwork.com/article.aspx?articleid=478724"]Neutrophilic Dermatosis (Pustular Vasculitis) of the Dorsal Hands[/url] might be a consideration given combination of neutrophilic vasculitis and pseudocarcinomatous epidermal hyperplasia. If more widespread, then the clinical context, and/or serology and/or direct immunofluorescence studies may give additional clues.

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Guest Maria George

Posted

In addition to very informative comment by Dr Davie,
what about erythema elevatum ditunium?Sprotrichosis?Verrucous tuberculosis?

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Guest Rodrigo Restrepo

Posted

Neutrophilic dermatosis of the dorsal hands

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Sasi Attili

Posted

Neutrophilic dermatoses of the hands was my first thought histologically but the clinical does not entirely fit (not a single lesion). I would therefore rule out an infective aetiology with appropriate stains as suggested by Dr. Maria. If infections are included and this is a single lesion, EED would be on top of my differentials.

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Robledo F. Rocha

Posted

Given the history case of an isolated finger plaque in an elderly woman and the microscopic features of a leukocytoclastic vasculitis, I will favor Osler’s node or other cutaneous lesion caused by septic embolus or immune complex disease due to distant bacterial focus (e.g. acute meningococcal infection).

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Robledo F. Rocha

Posted

I’d like to invite my colleagues to join me in welcoming Dr. Hurt as our new Chief Editor of DermpathPRO.

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Dr. Richard Carr

Posted

Welcome Mark! [i] My first thought was EED.[/i]

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Guest Dr. Wilber Martínez

Posted

[font=comic sans ms,cursive][size=4][b]Erythema elevatum diutinum[/b][/size][/font]

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Dr. Mona Abdel-Halim

Posted

First thought EED, second thought: infection.

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Dr. Mona Abdel-Halim

Posted

U r most welcomed Dr Mark,,,

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IgorSC

Posted

I agree with EED. Welcome Dr. Mark.

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Guest Romualdo

Posted

I think the presence of leucocytoclastic vasculitis, with fibrin in vessel walls, neutrophils and nuclear dust, given the clinical context, are consistent with the diagnosis of erythema elevatum diutinum. Welcome Dr. Mark Hurt!

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Mark A. Hurt MD

Posted

The diagnosis is erythema elevatum diutinum. Cultures were negative. Congratulations to everyone for working through the diagnosis!

Also, many thanks to everyone for that warm welcome. Finally, thanks again to Phillip for all of his contributions to the site and to Iskander for his persistence in getting things done.

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