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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 1668 - 16 November - Dr Hafeez Diwan 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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Clinical History: 17 year-old male with purpuric lesions. This biopsy is from the calf.

Case Posted by Dr Hafeez Diwan

Edited by Admin_Dermpath


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vincenzo polizzi

Posted

Yes. Agree. Hemocytophagic  Sindrome (mononucleosis?)

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Robledo F. Rocha

Posted

Subcutaneous foamy macrophages with phagocytosed erythrocytes, but no bean bag cells showing lymphophagocytosis. Maybe higher power view of the first image will reveal characteristic findings of lupus erythematosus (on low-power view, I suspect there is an interface lymphocytic infiltrate with perifollicular involvement). I favor lupus panniculitis.

Alternatively, all the cells on the superficial dermis I suspect to be lymphocytes are, in reality, extravasated erythrocytes. In this case, bleeding diatheses and other forms of non-inflammatory purpura are good suggestions.

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Dr. Mona Abdel-Halim

Posted

Actually I am facing difficulty in interpretating the photos :-(

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Telangectasia macularis eruptiva perstan.Aform of mastocytosis.

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Nitin Khirwadkar

Posted

As Robledo has mentioned there is a superficial dermal infiltrate, probably all lymphocytic. Focally, it is in a peri-follicular location. However, I am not sure about an interface pattern. There is fat necrosis. Within foci of latter are large histiocytes, with big nuclei, and some with erythrophagocytosis. I think I would favour cytophagic histiocytic panniculitis. No vasculitis. Require CPC.

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Raul Perret

Posted

I find this case challenging and hard to interpretate in these pictures. But I agree with the great suggesiton of cytophagic histiocytic panniculitis for CPC.

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Dr. Hafeez Diwan

Posted

I have tried to photograph hemophagocytosis.  I called this hemophagocytic lymphohistiocytosis.

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Dr. Richard Carr

Posted

Great case Hafeez. I'm a bit late.  I enjoyed this challenging case that I also struggled with!  Well done to those who thought of the diagnosis. I wanted to pass on a little anecdote.  We had a neighbour who whose child was wasting away and had had a diagnosis of HLH made on bone marrow biopsy (at another centre). He continued to deteriorate and things were looking bleak until fortunately (all be it late in the day) some clever pathologist when taking a further look at the bone marrow spotted the Leishmaniasis followed by appropriate treatment and a full recovery.

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