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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 1816 - 15 May - 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: 57 year-old female, right arm rash.

Case Posted by Dr Limin Yu


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Admin_Dermpath

Posted

Start your week off with a lovely case from Dr Limin Yu.

Geoff Cross - DermpathPRO Projects

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vincenzo polizzi

Posted

A PPD-like rash, with eosinophils and chronic-like dermal fibrosis, but with acute-like epidermal features ( no parakeratosis/hyperkeratosis ) makes me think of fixed drug eruption. 

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Raul Perret

Posted

I also thought of drug adverse effect Vincenzo

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Dr. Mona Abdel-Halim

Posted

Would like to R/O MF first and check drug history.. could be T cell pseudolymphoma (Lymphomatoid drug reaction) or MF

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Robledo F. Rocha

Posted

A superficial perivascular and interstitial inflammation of lymphocytes and plasma cells, with rare eosinophils, associated to wiry bundles of collagen and some extravasated erythrocytes in the papillary dermis. There's also lymphocyte tagging along dermoepidermal junction in the absence of spongiosis, disturbance of the stratum corneum, or another epidermal reaction pattern. I favor some sort of drug eruption, perhaps the fixed type, although prominent vacuolar change with apoptotic keratinocytes, deeper extension of the infiltrate, and neutrophils scattered interstitially are lacking.

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Saman Fatah

Posted

Could this be an early changes of extragenital lichen sclerosus mimicking a CTCL histologically. There is epidermal atrophy with changes of the collagen bundles at the most superficial part of papillary dermis. Clinically such plaques are highly distinctive and a simple genital examination can be rewarding rather than attempting to diagnose CTCL on the histology alone. While lesions of MF can occur at any part of the skin, isolated arm involvement will be slightly unusual as well clinically (if this is the sole site of the lesion).

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Sasi Attili

Posted

My first thought was inflammatory stage of Lichen sclerosus. Kept quiet as no one else mentioned it! 

11 hours ago, Saman Fatah said:

Could this be an early changes of extragenital lichen sclerosus mimicking a CTCL histologically. There is epidermal atrophy with changes of the collagen bundles at the most superficial part of papillary dermis. Clinically such plaques are highly distinctive and a simple genital examination can be rewarding rather than attempting to diagnose CTCL on the histology alone. While lesions of MF can occur at any part of the skin, isolated arm involvement will be slightly unusual as well clinically (if this is the sole site of the lesion).

 

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Dr. Mona Abdel-Halim

Posted

Very good suggestion of inflammatory LS !!

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Dr. Richard Carr

Posted

LS was my "spot diagnosis" but curious amount of haemosiderin! There are reports of vascuolopathic changes in genital LS.

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Nitin Khirwadkar

Posted

My differentials are LS and a drug reaction. I have had a case where LS had unusual amounts of hemosiderin.

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Limin Yu

Posted

I hope you enjoyed this case, the diagnosis is: Pigmented Purpuric Dermatosis

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