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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 1426- 10 December 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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Case History: 40/F 4 week history of rash staring on feet, knees and spreading to other parts of the body.

Case posted by Dr Arti Bakshi


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Raul Perret

Posted

What about granulomatous variant of pigmented purpuric dermatosis as a differential? the clinical history doesnt match but the histology made me think of it. There is a variant of sarcoidosis mimicking PPD also.

P/s: The last picture is not working

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Argee, my first thought. Granulomatous PPD. There have been several reports of it in the last years.

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Dr. Mona Abdel-Halim

Posted

As Raul and Igor, my first thought was granulomatous PPD, extension outside lower limbs is rare but can occur. My other thought was granulomatous drug reaction as Abdul-Kadir suggested. I think PPD like sarcoidosis referes to a clinical presentation mimicking PPD and a pathological picture typical of sarcoidosis.

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vincenzo polizzi

Posted

I'm thinking about some extra intestinal localization of Crohn disease, but i've never seen it!

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Guest Romualdo

Posted

I see some neutrophils and nuclear dust. I am thinking of erythema elevatum diutinum.

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Arti Bakshi

Posted

The first thought is often the best thought!... Yes, this is a case of granulomatous PPD with a combination of capillaritis and granulomata. It can be tricky on images, but I can confirm that there were no neutrophils in the section. The clinical presentation was of a purpuric rash with PPD as the main clinical consideration. Unfortunately, the original report by an outside pathologist focused only on the granuloma and patient had several investigations to rule out an infective eitiology. I think if one is not aware of this entity, it is easy to be misled. There have been several reports of this distinct entity with many showing an association with hyperlipedemia. The widespread nature was certainly unusual but has been described, as Mona rightly said. Thanks for the great discussion!

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