Case Number : Case 1803 - 26 April - Dr Hafeez Diwan Posted By: Guest

Dr Hafeez Diwan has a great case for you with interesting Clinical History.

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Geoff Cross - DermpathPRO Projects

Dermatomyositis?

I find the pale sections very difficult to read especially with my colour blind eyes!!! :(

Mild parakeratosis with a sparse perivascular infiltrate with eos and neuts with mild dermal edema on a background of solar elastosis. Few neus also present subcorneally.

 I am not sure about it but is that mucin in the dermis in the 3rd pic left hand column? Not sure how to fit it in. 

Drug rash?

guttate psoriasis

I would go for early guttate psoriasis. One of the images shows a well developed dermal papilla+ the history. GP often follows a streptococcal infection. Can never rule out a drug reaction with any pattern.

Yes Raul. You are right! 

 GP is the best diagnosis, because it's more in keeping with clinical history and because histological features fit very well.

Have to say- Did not consider guttate psoriasis- given the description of a 'desquamating rash'. A bit unusual too for guttate psoriasis to present this late in life. 

"Desquamating rash" together with the path made me think of drug reaction (subsiding lesions of AGEP), one see desquamation in these cases as they tend to resolve. 

Clinical history makes the possibility of guttate psoriasis less likely. Drug eruption can simulate any cutaneous inflammatory disease. Neutrophilic infiltrate, including many neutrophils in the lumina of dilated vessels of the superficial plexus, reinforces this hipothesis. So, I favor drug eruption elicited by antibiotics or anti-inflammatory drugs used to treat the sore throat.

The clinical is essential in this case.  She had a strep throat, and the clinical impression was scarlet fever.  The features are quite non-specific, as you can see, but fit with the descriptions of scarlet fever.