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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 1092 - 29th 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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F60 Urticarial eruption with vesicles and bullae on legs.

Case Posted by Dr Richard Carr


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Guest Romualdo

Posted

I see an intraepidermal neutrophil rich vesicle. The last three images show neutrophilic spongiosis. IgA pemphigus?

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Mark A. Hurt MD

Posted

I favor some sort of acute toxic reaction: bullous bite? bullous drug?

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This is a bullae with reepitelization rich in eosinophils and neutrophils. Considering the clinical pictures of urticarial eruption I think this case is Bullous pempigoid rich in neutrophils.

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Dr. Mona Abdel-Halim

Posted

Neutrophil rich BP (re-epithelialized subepidermal blister). Still DIF is mandatory.

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Robledo F. Rocha

Posted

Neutrophil-predominant subepidermal blister in re-epitheliazation. Giving the age of the patient and the lack of neutrophilic collections at neighbouring dermal papillae, I go with bullous pemphigoid until immunofluorescence prove otherwise.

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Arti Bakshi

Posted

Agree with Vesicular Bullous pemphigoid with re-epithelisation

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Dr. Richard Carr

Posted

Well I have every symphathy with all of the above but IMF studies showed features of pemphigus vulgaris. I put this case in as a curiously neutrophil rich and spongiotic stage of the disease. I don't think this is re-epithelialisation as it looks a very acute blister. Although textbooks emphasise eosinophils in PV I have found dissappointingly few in more than a few cases over the years. Bottom line IMF often gussumps histopathology in blistering conditions.
Enjoy your weekends.

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