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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 1774 - 16 March - Dr Arti Bakshi 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: 58/F, unusual rash ?sarcoid ?drug related.

Case Posted by Dr Arti Bakshi

Edited by Admin_Dermpath


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Raul Perret

Posted (edited)

My spot diagnosis is granulomatous PPD but is hard to rule out drug related eruption just based on the histology as all the colleagues know. Clinical information should help. Does not look like sarcoidosis or infectious to me.

Edited by Raul Perret

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Victor Delgado

Posted

Agree, Granulomatous pigmented purpuric dermatosis.

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Alice Roberts

Posted

Granulomatous dermatitis, favor granulomatous PPD... iron stain helpful

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vincenzo polizzi

Posted

What about a granulomatous mycosis fungoides?

 

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Neil Catterall

Posted

What about interstitial granulomatous drug reaction (dermatitis) - need more clinical history. Usually involves skin folds. 

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Dr. Mona Abdel-Halim

Posted

I also thought of interstitial granulomatous drug reaction more than gran Pigm Purp Der... it needs clinical correlation

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My first impression was Granulomatou PPD, second one was MF or even an unusual PPD-like MF. Need CPC.

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vincenzo polizzi

Posted

Intraepidermal lymphocytes are twice large than dermal ones...

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Dr. Mona Abdel-Halim

Posted

Good thinking Vincenzo... 

Second look on the photos, it could be MF yes... 

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Admin_Dermpath

Posted

Dr Arti Bakshi has given me another half dozen images to upload, so take a look and see what you think now...

 

Geoff Cross - DermpathPRO Projects

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Mariantonieta Tirado

Posted

I like granulomatous MF. Epidermotrophism with tagging along DEJ, atypical lymphocytes, wiry collagen, band-like infiltrate, Clinical could fit, differential drug but I didn't see necrotic keratinocytes 

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Raul Perret

Posted (edited)

After the new pictures agree with Vincenzo and the colleagues that suggested MF. Nice case

Edited by Raul Perret

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Robledo F. Rocha

Posted

Granulomatous mycosis fungoides. After immunohistochemistry images, the task became less challenging, but nonetheless still challenging. Kudos for Vincenzo, who hit the nail on the head with only HE images.

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Alice Roberts

Posted

This nicely illustrates the histologic overlap one can see between PPD and MF.  Also a lesson for me in resisting the power of certain features to draw the eye away from others, i.e red cells and histocytes distract from epidermotropism of lymphocytes.  Beautiful case! 

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Arti Bakshi

Posted

Yes, this is Granulomatous mycosis fingoides!

 The full clinical history was of patches and plaques thought to be consistent with MF on review by dermatologist. I accept I was a bit cheeky in the initial images as I purposely focussed on the granulomata, However, it is easy to get misled by these and ignore the real pathology in real life too, as pointed out nicely by Alice. So definitely a big 'well done' to Vincenzo for spotting the lymphoid atypia and tagging in the initial images...he clearly wins the prize for the sharpest eyes on this case!!

Thanks for all your valuable comments.

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Arti Bakshi

Posted

Forgot to add....many thanks to Dr Naveen Sharma for sharing this lovely case with me.

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