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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 977 - 21st March 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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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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Go to records March 2014

User Feedback


Dr. Richard Carr

Dr. Richard Carr 622

Posted

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

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Guest
?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

Dr. Mona Abdel-Halim 508

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

Eman El-Nabarawy 69

Posted

Thought of yaws!! Mother yaws and secondary lesions.

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Dr. Richard Carr

Dr. Richard Carr 622

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

Dr. Mona Abdel-Halim 508

Posted

Seems Dr Abdul Kadir was right, Borreliosis...

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Eman El-Nabarawy

Eman El-Nabarawy 69

Posted

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

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Robledo F. Rocha

Robledo F. Rocha 336

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

Dr. Richard Carr 622

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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