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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 839 - 4th September 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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59-year-old male with recurrent papular lesion on dorsal forearm for 2-3 months. He traveled to Grand Cayman 6 months ago an to Honduras within the last 2 years. The biopsy is from an ulcerated lesion on dorsal left forearm.


Case posted by Dr. Hafeez Diwan.
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Go to records September 2013

User Feedback


Arti Bakshi

Arti Bakshi 286

Posted

Blue staining granules (?bacteria) with surrounding Splendore- Hoeppli phenomenon
?Botyromycosis ??Actinomycosis

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Robledo F. Rocha

Robledo F. Rocha 336

Posted

I go with botryomycosis unless special stains prove otherwise. Grains appear as basophilic granules rather than filamentous.

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Dr. Richard Carr

Dr. Richard Carr 622

Posted

Botryomycosis was my first consideration, most likely some Staphylococcus?

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Dr. Mona Abdel-Halim

Dr. Mona Abdel-Halim 508

Posted

Botryomycosis is my first impression also,,, lovely :-)

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Guest Jim Davie MD

Guest Jim Davie MD

Posted

Favor Staphylococcal botyromycosis (agree with Richard).

The bacteria are forming closely packed, but distinct tetrads (squares of 4 cocci) plus clusters, which is common in Staphylococcus (doubt Micrococcus). I don't see filamentous bacteria suggestive of a coexistent Actinomycete. Differential Dx would include incidental cocciform impetiginization, as a distraction in a lesion caused by something else not easily seen in these photos (foreign body, fungus, etc). Staining for fungus would be prudent.

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