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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 1349 - 25 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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35 year old woman with numerous edematous erythematous plaques on the trunk.

Case posted by Dr Uma Sundram


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Dr. Richard Carr

Posted

Nice floating collagen sign!! Igor have another think.

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Guest Romualdo

Posted

Interstitial granulomatous dermatitis?

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Arti Bakshi

Posted

Was thinking of morphoea on the images and Dr Carr's clue is helpful!
'Floating sign' is presence of histiocytes around floating isolated collagen bundles, described in morphoea. Collagen bundles are swollen and there is both interstitial and perivascular infiltrate.
The inflammation is quite intense (probably a pseudolymphomatous variant of morphoea).
An interstitial GA might come in the differential, but I think too deep seated and wouldnt expect thickening of collagen.

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Guest Romualdo

Posted

The "floating sign" is also described in interstitial granulomatous dermatitis as focal degeneration of collagen surrounded by empty spaces.

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Arti Bakshi

Posted

good point Romualdo, I think you are right!

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Dr. Mona Abdel-Halim

Posted

I think we r having esinophils also, with the clinical I thought of interstitial granulomatous drug reaction

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Dr. Richard Carr

Posted

Agree with Arti, morphoea would be my first thought (clinical sounds okay) and I can sense plasma cells!! Differential does include interstitial GA as Arti mentions and I agree with her considerations. I suspect interstitial granulomatous dermatitis (assoc. with many systemic conditions), interstitial drug reaction and Lyme disesae less likely in this case with the pattern and history. I have seen the floaing sign in GA personally and I know it has been mentioned in morphoea in Am. J. Dermpath. in last couple of years. Nice case for discussion and looking forward to the answer.

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Yes, I did not pay suffient attention to the floating sign. So much that I comment about it!!!

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Uma Sundram

Posted

Great discussion everyone. Clinical + histopath fit best for interstitial granulomatous dermatitis with nice floating collagen sign.

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