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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 1756 - 20 February - Dr Limin Yu 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: 61 year old male bullae on right thigh.

Case Posted by Dr Limin Yu

Edited by Admin_Dermpath


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Admin_Dermpath

Posted

'Short and Sweet' here is your Spot Diagnosis Case from Dr Limin Yu to get your week off to a great start.

 

Geoff Cross - DermpathPRO Projects

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vincenzo polizzi

Posted

A tricking case: half Sweet Syndrome ( sub epidermal blister and dermal neutrophilic infiltrate ) half Subcorneal Pustular Dermatosis/Sneddon Wilkinson ( pustular sub corneal component ). My spot is Sneddon Wilkinson, but maybe an association...

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Robledo F. Rocha

Posted

Assuming that clinical manifestation may be intact pustules, IgA pemphigus and miliaria crystallina are my favorite hypotheses if non-intertriginous areas are affected, and subcorneal pustular dermatosis of Sneddon-Wilkinson if the flexor aspect of the proximal lower limb is the site of the lesions.

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Dr. Mona Abdel-Halim

Posted

I think it is predominately subepidermal. Neutrophil mediated. Seems localized to right thigh. Sweet is a possibility but would have expected more dermal neutrophils, a clinical of nodules and plaques that may have surface vesiculation which is not the case.  I am thinking more in the line of localized neutrophil mediated BP. Prebullous stages may show spongiosis and intraepidermal vesicles which can explain the focal intraepidermal component here. This is my theory and waiting for DIF images !! I mean with neutrophil mediated BP, the anti p105 and the anti 200 types

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Raul Perret

Posted

Although I dont see eosinophils, I would add bullous drug eruption to the differential.

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Arti Bakshi

Posted

Tricky case....my impression was that the subcorneal pustule is the main inflammatory reaction pattern and the subepidermal oedema is secondary. Hence would consider d/d of subcorneal pustular reaction including IgA pemphigus, AGEP etc....need more clinical info.

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Nitin Khirwadkar

Posted

I too think that the subcorneal pustule is the main pathology. Would favour IgA pemphigus and other differentials. Clearly, DIMF and clinical picture needed.

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Sasi Attili

Posted

Agree with all the above differentials above. But given the localised reaction- would consider impetigo (grams?). Herpes is also a possibility depending on clinical (though fail to see any tzanck cells in these sections). Other possibilities include an insect bite reaction. CPC is a must +- DIF.

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This is an AGEP. Agree with all the above differential diagnosis.  You guys are awesome!!

 

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