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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 1337 - 07 August 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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F60. Rash on vancomycin. c/o Dr Nick Tiffin

Case posted by Dr Richard Carr


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Arti Bakshi

Posted

Busy superficial dermis with a perivascular and interstitial infiltrate (includes eosinophils). I think many of the oval/ spindle cells may be mast cells, so would do CD117 stain. Increased basal pigmentation, possible subtle interface change
D/D - urticaria pigmentosa vs drug reaction.

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I think this is a drug reaction with many histiocytoid mononuclear cells that are in fact immature myeloid cells. A pattern that can be seen in some cases of Histiocytoid Sweet Syndrome.

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Dr. Mona Abdel-Halim

Posted

I think this is a drug reaction.
The last image is showing large atypical cells, ? Atypical lymphocytes.
Could it be lymphomatoid drug reaction (drug induced pseudolymphoma)
Any CD30?

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Mark A. Hurt MD

Posted

Looks like a hypersensitivity reaction to me.

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Dr. Richard Carr

Posted

This was a case of DRESS (Drug reaction with eosinophilia and systemic symptoms). You did not appear to appreciate the few necrotic keratinocytes and lymphocyte exocytosis. Given that the cornified layer is normal but there is a plenty going on in both the epidermis and dermis one can predict a very acute rash so DRESS would be a good contender with the combination of interface / lichenoid pattern and eosinophils.

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