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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 1540 - 19 May 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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49-year-old Hispanic man presents with a 4-week history of non-healing ulcerations on the right lower leg. The patient previously complained of dyspnea, sore throat, dry cough, and arthralgias. A CT chest without contrast showed very mild scattered areas of ground-glass opacities with no specific distribution.

Dr Hafeez Diwan


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Raul Perret

Posted

This is clearly a systemic vasculitic disease and as Sasi asked, the next question should be what are the ANCA values of the patient and if there is any affection of renal function. We see an ulcer and compromise of medium sized vessels the differential for me is between granulomatosis with polyangeiitis vs eosinophilic granulomatosis with polyangeiitis. And as Sassi I favour Wegeners due to the absence of eosinophils and reference to asthma, eosinophilia, p-anca. If we saw compromise of small vessels (which I dont think is the case) other differentials could include connective tissue disease related vasculitis and microscopic polyangiitis.  

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Guest Arash Daryakarr

Posted

vasculitis more in favor of Wegener's. laboratory data such as serum c-ANCA can help.

although,in ulcerated skin lesions the diagnosis can be hard since secondary vasculitis can be found in the base of ulcers.

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Nitin Khirwadkar

Posted

Epithelial necrosis and ulceration. A vasculitic process affecting the medium sized blood vessels, possibly a vague granuloma in the last image. Findings favouring Wegener's granulomatosis.

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Dr. Mona Abdel-Halim

Posted

Agree with Wegner's (granulomatosis with polyangiitis)

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vincenzo polizzi

Posted

Wegener' granulomatosis fits well with clinical history but is an odd pathological sight: I don't see any granulomatous component or dermal necrosis. It looks like a ischemic epidermal necrosis secondary to vasculitis, PAN-type. Has the patient been treated with minocycline?

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Dr. Hafeez Diwan

Posted

Indeed.  This is Wegener's. 

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