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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 1469 -10 February 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: 62 year-old male with biopsy of right cheek lesion.

Case posted by Dr Hafeez Diwan


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Raul Perret

Posted

Seem like acute superficial folliculitis and perifolliculitis probably of fungal ethiology. I would perform special stains, it looks like septated but to be honest I am not 100% sure with the pictures, they also look like elastic fibers... 

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vincenzo polizzi

Posted

Fungal suppurative granulomatous folliculitis ( Trichophyton rubrum? )

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Raul Perret

Posted

My other differential was elastosis perforans serpiginosa that usually affects the face but there is too much inflammation on the dermis. Special techniques are important would perform PAS, Grocott, orcein,

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Nitin Khirwadkar

Posted

Herpes. Multinucleate cells in wall of the follicle, with margination of chromatin. Look like septate hyphae, when looked at fleetingly!  Some elastin fibres are also noted.

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Dr. Hafeez Diwan

Posted

Herpes simplex folliculitis.  Immunohistochemistry (HSV) nicely highlighted these multinucleated cells in the wall of the follicle.  

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Arti Bakshi

Posted

Never thought herpes inclusions and fungal hyphae could be confused with each other! Have to admit I thought fungal too, so  we all fell into the trap (except ofcourse the great Dr Carr, who obviously did not have any doubts!)

Great case!

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