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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 1062 - 18th 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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F20 Fever, cervical lymphadenopathy, rash comprising nodules and plaques over face and upper limbs (c/o Dr Tan Kong Bing & Lee Yoke Sun, National University Hospital, Singapore)

Case posted by Dr. Richard Carr.


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Mark A. Hurt MD

Posted

I'm not sure what it is, but I wonder if it could be some kind of infection, as the histiocytes contain delicate, frothy material. Leprosy?

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I´m not so confortable with the vacuolated cells too. They could represent infectious agent but I think they are hemophagocytosis associated with SLE. Stains are necessary.

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Dr. Mona Abdel-Halim

Posted

I am also suspicious about these foamy cells with shreddy material, I will exclude Leprosy first.

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Guest Romualdo

Posted

Erythema nodosum leprosum?

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Arti Bakshi

Posted

Interface change with apoptotic keratinocytes, histiocytes with karyorrhectic debris, (coupled with young female with cervical LNpathy and fever), makes me think of Kikuchi's disease.

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Dr. Mona Abdel-Halim

Posted

[quote name='arti bakshi' timestamp='1405687116']
Interface change with apoptotic keratinocytes, histiocytes with karyorrhectic debris, (coupled with young female with cervical LNpathy and fever), makes me think of Kikuchi's disease.
[/quote]



This is it,
I AGREE Arti Bakshi :-)

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Robledo F. Rocha

Posted

Dr. Bakshi is right. Case history and microscopic images are of Kikuchi's disease. However, I fell uncomfortable to consider Kikuchi's disease something other than lupus erythematosus.

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I confess I didn't think of Kikuchi's. The clinical details could as well be those of SLE (young woman, fever and lymphadenopathy) and Kikuchi's would not be on the top of your list in Britain. On top of that, the pathology of the skin (and lymph node) lesions in the two diseases are not dissimilar. The late Ronald Dorfman proposed that Kikuchi's is a self-limiting form of SLE and recommend that patients with Kikuchi's be followed up make sure that they do not develop SLE ([url="http://www.ncbi.nlm.nih.gov/pubmed/3217625"]http://www.ncbi.nlm..../pubmed/3217625[/url]).

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Dr. Richard Carr

Posted

Well done Arti putting together the histology (lupus like with lymphoid apoptosis) with the the clinical. Indeed this was a case of Kikuchi's.
A wonderful case I hope you will agree.
Enjoy your weekends
Richard

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