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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 1089 - 26th 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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The Patient is 52-year-old male with infectious process on the glans penis, now with 6 mm pustule with surrounding hyperpigmentation on the left foot. Biopsy of left dorsal foot.

Case posted by Dr.Uma Sundram


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Dr. Mona Abdel-Halim

Posted

The lesion represent vasculopathic process. Clinical correlation suggests developing gonococcal septicemia.

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Difficult case. I´m having trouble associating the infectious process of the glans penis and the foot ulcer. My first thought is that this is not an infectious process, but an ulcer on glans penis and foot caused by Beçhet disease. My second opinion is an infectious emboli to the foot of an unknow infectious agent from the penis.

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Robledo F. Rocha

Posted

Despite acral pustules be common in gonococcemia, case history mentions an infectious process on the glans penis, but not an urethritis, which is the major manifestation of gonococcal infection in men. Furthermore, arthritis was not reported.
Images may represent patergic phenomenon of Behçet's disease, but this hypothesis also have its problems. Genital ulcerations are not common on glans, but scrotal involvement is typical. And [url="https://dermpathpro.com/index.html/_/latest-news/the-new-proposed-criteria-for-behcet%E2%80%99s-disease-r55"]other clinical findings[/url] of Behçet's disease were not mentioned.
On the other hand, diseases do not use to read medical books, and the two above hypotheses are valid.

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Uma Sundram

Posted

We called this a vasculopathic process, possibly an embolus from the penile infection. We could not grow any organisms from either site and special stains were negative. I thought this was a nice example of wedge shaped necrosis that one can see from an embolic process. Behcet's disease is an excellent thought but did not fit clinically.

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