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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 1063 - 21st July 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 79 year old white woman with a history of pruritic, vesicular bulbous lesions on the arms, legs and trunk. Punch biopsies for H&E microscopy and direct immunofluorescence of the areas near the papules are taken from A and B - the peri-lesional skin.

Case posted by Dr. Mark Hurt
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  Report Record
Go to records July 2014

User Feedback


Dr. Mona Abdel-Halim

Dr. Mona Abdel-Halim 508

Posted

Since there is no history of mucous membrane affection, I will call it bullous erythema multiforme.

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IgorSC
Interface dermatitis with extensive epidermal necrosis. It can be either EM or SJ/TEN, cutaneous clinical picture is important. I think clinically, the DDx should have been BP.

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Dr. Richard Carr

Dr. Richard Carr 622

Posted

Very "inflammatory" for EM / TEN but the nice basket weave keratin (of an eruptive dermatosis) would support. Also consider paraneoplastic pemphigus (EM-like pattern) and PLEVA and Rowell's syndrome (deeper infiltrate lupus like). Purely on histology with some odd cytopathic nuclear changes would also have considered herpes / zoster group.

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Robledo F. Rocha

Robledo F. Rocha 336

Posted

Erythema multiforme herpeticum due to extensive epidermal necrosis with preservation of the basket weave pattern of the stratum corneum. Cytopathic effect suggestive of herpesvirus infection is now highlighted by immunostains.

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Uma Sundram

Uma Sundram 169

Posted

Agreed, herpetic dermatitis. When you go back to the highest power micrograph, there is a cell demonstrating viropathic effects.

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