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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 999 - 22nd April 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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The patient is a 43 year old white man with punch biopsies for H&E microscopy and direct immunofluorescence taken from the left knee.

Case posted by Dr. Mark Hurt.


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Guest Tiberiu Tebeica

Posted

Subepidermal blister and a neutrophil-rich infiltrate, with suggestion of papillary microabscesses in the vicinity of the blister. Most probable diagnosis is dermatitis herpetiformis, but DIF is needed to exclude linear IgA dermatosis, bullous LE and eosinophil-poor BP. Other unlikely differentials are acquired EB and DH-like drug eruption.

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Dr. Mona Abdel-Halim

Posted

[quote name='Tiberiu Tebeica' timestamp='1398159299']
Subepidermal blister and a neutrophil-rich infiltrate, with suggestion of papillary microabscesses in the vicinity of the blister. Most probable diagnosis is dermatitis herpetiformis, but DIF is needed to exclude linear IgA dermatosis, bullous LE and eosinophil-poor BP. Other unlikely differentials are acquired EB and DH-like drug eruption.
[/quote]


Totally agree, u said it all Dr Tiberiu,,,, especially in the absence of any clinical details....

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Guest Jim Davie MD

Posted

Agree with Tiberiu's excellent differential, with DH as most likely diagnosis given age/location, followed by BP. I would add arthropod assault to the differential, albeit less likely consideration given clinical location, and the clinical hint that DIF was ordered for a presumed multifocal bullous dermatosis.

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Mark A. Hurt MD

Posted

Here is the direct IF. I will post my diagnosis somewhat later today.

[img]https://dermpathpro.com/uploads/spot_diagnosis_comment_img/CASE999_Image%2008.jpg[/img]

[img]https://dermpathpro.com/uploads/spot_diagnosis_comment_img/CASE999_Image%2009.jpg[/img]

[img]https://dermpathpro.com/uploads/spot_diagnosis_comment_img/CASE999_Image%2010.jpg[/img]

[img]https://dermpathpro.com/uploads/spot_diagnosis_comment_img/CASE999_Image%2012.jpg[/img]

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Guest Tiberiu Tebeica

Posted

It seems that this is bullous LE...!?

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Dr. Mona Abdel-Halim

Posted

Multiple immunoreactants favour EBA or Bullous SLE , I think we need clinical data now.

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Robledo F. Rocha

Posted

Direct immunofluorescence findings favor epidermolysis bullosa acquisita and bullous lupus erythematosus, but the cell-rich infiltrate and the granular pattern of the immunoglobulin deposits suggest bullous lupus erythematosus, although the trauma-prone site of the lesion is typical of epidermolysis bullosa acquisita.

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Mark A. Hurt MD

Posted

My diagnosis was bullous DH. Clinically, the patient had DH with a differential of IgA linear dermatosis or bullous "eczema." Lupus and EBA were not in the differential clinically. If I learn any additional information in follow-up, I will post it on this page.

Thanks, everyone!

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