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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 1750 - 10 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: M55. Indurated erythematous plaque on the cheek.

Case Posted by Dr Richard A Carr

Edited by Admin_Dermpath


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Admin_Dermpath

Posted

Round off your week with another great case from Dr Richard A Carr

 

Geoff Cross - DermpathPRO Projects

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Arash Daryakar

Posted

I think of DLE at first look. although due to presence of eosinophils one can think of drug induced LE.

another thing is presence of nuclear debries among inflammatory cells.leukocytoclasia??

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Agree that there are findings which makes me think about Lupus: interface change, thickening of the basement membrane in figure 8, many lymphoid nodules extending to subcutaneous tissue, perifollicular inflamation and telangiectasias. The neutrophils may be in a context of a LE with neutrophils.

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Raul Perret

Posted

Well me I had the impression of a really inflammatory rosacea / demodicosis. There is telangiectasia, demodex and I had the impression that the inflammation is mainly centered on hair follicles. I would definately do a PAS staining too here. 

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Arti Bakshi

Posted

All good thoughts above. Just to add to the d/d what about an odd Granuloma faciale? The images with mixed infiltrate (neutrophils and eosinophils) with leucocytoclasia would very well for GF But there is no Grenz zone and difficult to explain the dense perivascular and periadnexal lymphocytic infiltrate. Difficult!

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vincenzo polizzi

Posted

I think there are two manifestations of the same disease: Lupus Erythematosus. 

A chronic cutaneous lupus and a lupus profumdus. I don't know exactly what it's happening in this patient but may be some drug could have blown up a chronic autoimmune status in his face. 

"Neutrophils in the setting of systemic lupus erythematosus (SLE) are commonly associated with bullous disease. Rare cases of nonbullous neutrophilic lesions have been reported in patients with SLE".

Nonbullous neutrophilic lupus erythematosus: a newly recognized variant of cutaneous lupus erythematosus.

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Nitin Khirwadkar

Posted

Looks like DLE as the basic process. Can't go away from the markedly thickened basement membrane. Eosinophils and neutrophils, slightly odd. So, GF with DLE?

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Dr. Mona Abdel-Halim

Posted

DLE/LE profundus is my prefered hypothesis... neutrophils can occur in the context of lupus. Esinophils r sparse, odd in LE ?? But can't think of something else. 

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Dr. Richard Carr

Posted

Glad you guy's also found this case challenging. Agree the main pathology is the discoid lupus (DLE). I was confused by the eosinophils and neutrophilic leucocytosis (these were mainly quite deep and in one area of this generous incision biopsy. My thoughts were similar to the responses i.e. it could all be a manifestation of lupus or perhaps dual pathology - granuloma faciale-like. Sometimes there is a call to speculate in the reports which is what I did on this case mentioning both possibilities.  It is recent but i'll try to get some follow-up and post later.

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