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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 1803 - 26 April - 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: 62 year-old female with widespread, desquamating rash and sore throat. This biopsy is from the right forearm.

Case Posted by Dr Hafeez Diwan


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Sasi Attili

Posted

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?

 

 

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Nitin Khirwadkar

Posted

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.

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vincenzo polizzi

Posted

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.

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Sasi Attili

Posted

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. 

 

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Dr. Mona Abdel-Halim

Posted

"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. 

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Robledo F. Rocha

Posted

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.

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Dr. Hafeez Diwan

Posted

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.

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