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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 1745 - 3 February - Dr Richard A Carr 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: F50. Several crusted nodules along the radial border of the thumb and radial border of the left wrist extending proximally.

Case Posted by Dr Richard A Carr


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Admin_Dermpath

Posted

This is definitely a 'Spot' case, have fun and enjoy your weekend

 

Geoff Cross - DermpathPRO Projects

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Victor Delgado

Posted

This is a very interesting case. There are several granulomas types including suppurative, tuberculoid and histiocytic with necrosis and giant cells. My bet is for Sporotrichosis. There is some blue-gray material...Granulomatous foreing body reaction and Rheumatoid Nodule are my differential diagnosis.

 

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Dr. Mona Abdel-Halim

Posted

Atypical mycobacteria vs. Sporotrichosis for stains and culture. 

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Sporotrichosis is also my first impression. It is very difficult to see the fungi. The suppurative granulomas and the clinical description resembling a lymphangitic spread of the disease favor this diagnosis.

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Alice Roberts

Posted

Given the clinical and H&E favor infectious, especially sporotichosis. Would do PAS and AFB and recommend cultures, even if negative.

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Nitin Khirwadkar

Posted

Suppurative granulomatous inflammation. Agree with Sporotrichosis ( clinical picture fits). Would also consider an atypical mycobacterial infection/ ' Fish tank' granuloma.

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vincenzo polizzi

Posted

The clinical description of lesional location reminds me of some wound patch, so agree with Sporotrichosis, but also with Fish Tank Granuloma.  I don't know the exactly answer....

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Dr. Richard Carr

Posted

Well done all on the correct differential.  This woman worked in a pet shop washing out fish tanks without protective equipment and this was clinically suspected to be Fish Tank granuloma. I reported it as suppurative granulomas in keeping with mycobacterium marinum.  I did not actually do Zn but I think I read in Weedon years ago that it is positive in up to 50% of cases.  I have not seen a case of sporotrichosis in the UK and will be very grateful to receive a case to photograph for Dermpathpro spot diagnosis.  I understand that it is one of the few conditions in which serial sections may be indicated to help find the organisms in the centre of the granulomas. It is one of my bug bears (pun intended) hearing people talk about serial sections when they mean step sections.  Serial sections produce a lot of slides! The blue grey material is elastophagocytosis - rather dramatic in this case but basically a secondary process - I'd hope it would lead to some confusion but you guys are too good!!

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