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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 1334 - 04 August 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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65 year old male with multiple deep seated nodules on the bilateral elbows.

Case posted by Dr Uma Sundram


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Guest Romualdo

Posted

If there is no clinical and laboratory evidence of rheumatic disease I vote for deep (subcutaneous) granuloma annulare.

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Arti Bakshi

Posted

Pseudo rheumatoid nodules (Deep GA) vs rheumatoid nodule (based on clinical)

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Based on clinical information and the extend of necrobiosis I go for Rheumatoid nodules.

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Guest Romualdo

Posted

At the left side of top right figure I see an histiocytic infltrate that looks more interstitial than palisading. Maybe this is more in keeping wtih granuloma annulare than a rheumatoid nodule. And there is more mucin than fibrin in this nodule.

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Uma Sundram

Posted

Oh good, I thought this would be too easy but completely agree with ddx of deep GA vs rheumatoid nodule. Patient has RA so I thought this was rheumatoid nodule. I thought this was interesting because it's more superficial than most cases of rheumatoid nodules I've seen. There's also quite a bit of mucin. It just goes to show how difficult these supposed 'easy' cases can be and how critical the clinical is.

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