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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 977 - 21st March 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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M40. Insect bite in Mexico, ulcerated, painless, non-healing ulcer on dorsum of finger (A image 1-3); Two week blotchy rash on trunk and upper limbs (B image 4-6)

Case posted by Dr. Richard Carr.


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Dr. Richard Carr

Posted

Image 1, 3 and 6 are from the the blotchy trunk rash as I am sure you all appreciated.

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?Borreliosis. I'm thinking the ulcer is the site of a tick bite and the secondary rash, a perivascular plasma cell-rich infiltration, is a consequence of spread of the spirochetes.

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Dr. Mona Abdel-Halim

Posted

I think this is just a spider bite causing skin ulcer at site of bite and allergic reaction on the trunk and extremities.

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Eman El-Nabarawy

Posted

Thought of yaws!! Mother yaws and secondary lesions.

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Dr. Richard Carr

Posted

[img]https://dermpathpro.com/uploads/spot_diagnosis_comment_img/Case977_RAC6055Bx60_TP_MR.jpg[/img]

[img]https://dermpathpro.com/uploads/spot_diagnosis_comment_img/Case977_RAC6055Ax60b_TP_arrows.jpg[/img]

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Dr. Mona Abdel-Halim

Posted

Seems Dr Abdul Kadir was right, Borreliosis...

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Eman El-Nabarawy

Posted

Treponemes within the epidermis, dermal papillae and around the blood vessels. Still thinking of Yaws!!

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Robledo F. Rocha

Posted

[font=arial,helvetica,sans-serif][size=4]Agree with Dr. El-Nabarawy. Case history favors yaws. Furthermore, the presence of spirochetes in epidermis is a typical microscopic finding of yaws.[/size][/font]

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Dr. Richard Carr

Posted

We reported this as a primary chancre of syphilis on the finger and seconday syphilis. The antibody was to treponema pallidum (kindly preformed by Dr Heinz Kutzner, Friedrichschafen, Germany). The suggested insect bite we believe to be a red herring. There was strong evidence that this was a sexually transmitted case. About 5 to 10% of syphilitic chancres are extra-genital (mainly oral). Digital primary chancre is uncommon but has been reported. In this case VDRL and TPPA were postive and TP IgM EIA was detected. I confess we did not think of yaws.

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