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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 1189 - 13th January 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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50 year old woman with erythematous rash on face and papules on fingers.

Case posted by Dr Uma Sundram


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Eman El-Nabarawy

Posted

Dermatomyositis and The biopsy from Gottron's papules on the hands. DD: photosensitive lichenoid drug reaction.

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Dr. Richard Carr

Posted

Thought some of you might like to know one of our regular contributors Dr Nick Turnbull passed the ISDP diploma.

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The case history and mucinosis suggests Gottron papules, while the density of inflammation and presence of eosinophils suggest a lichenoid drug reaction, but the history doesn't seem to fit the latter.

And congratulations to Dr Turnball.

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[quote name='I. Abdul-kadir' timestamp='1421150703']
The case history and mucinosis suggests Gottron papules, while the density of inflammation and presence of eosinophils suggest a lichenoid drug reaction, but the history doesn't seem to fit the latter.

And congratulations to Dr Turnball.
[/quote]

Agree. The eosinophils doesn´t fit with Dermatomyositis and suggest lichenoid drug reaction.

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Arif Usmani

Posted

Agree with the differential and favor dermatomyositis on the basis of clinical presentation

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Dr. Mona Abdel-Halim

Posted

I think it is a Gottron's papule with the evident dermal mucin...
Congratulations Dr Nick Turnbull :-))

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Guest Romualdo

Posted

Agree with the above differential. Density of the infiltrate, presence of eosinophils and paraceratotic foci suggest drug eruption.

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Robledo F. Rocha

Posted

A difficult case. Eosinophils in the infiltrate [url="http://onlinelibrary.wiley.com/doi/10.1111/j.1600-0560.2012.01891.x/abstract;jsessionid=A990EA8A65CB3E0E7BFE17EFE727E57F.f03t04"]argue against[/url] lupus erythematosus and dermatomyositis. Copious mucin between collagen fibers is not a feature of drug eruption. I’ve never seen a case of eosinophilia-myalgia syndrome, and I suppose this disease is very rare nowadays, but both eosinophils and mucin can be found in early pre-sclerotic lesions.

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Robledo F. Rocha

Posted

Many thanks to Dr. Carr for letting me know about the success of Dr. Nick Turnbull. Congratulations to him!

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Uma Sundram

Posted

Very difficult case and great comments. The patient on clinical presentation had a heliotrope rash and what was thought to be Gottron's papules. The biopsy is from a Gottron's papule. I too was thrown by the dense, almost lichenoid appearance of the infiltrate and the presence of eosinophils. However, the patient was not on any medications, including L-tryptophan. Blood eosinophil levels were normal. I was struck by the presence of significant dermal mucin, not a finding I have seen in typical lichenoid processes such as LP or lichenoid drug. Given the clinical setting, I favored an unusual histologic presentation of dermatomyositis.

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