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 2053 - 19 April 2018 Posted By: Iskander H. Chaudhry

Please read the clinical history and view the images by clicking on them before you proffer your diagnosis.
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55 year old female: Clinically capillaritis last biopsy.


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Anil Patki

Posted

Lymphocytic capillaritis with loosely formed granuloma of epithelioid cells and giant cell- granulomatous variety of pigmented purpuric dermatosis

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vincenzo polizzi

Posted

What about a morbilliform expression of hemophagocytic LymphoHistiocytosis?

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Admin_Dermpath

Posted

From Dr Chaudhry: 
 
Thank you for your comments:
 
Would you still accept  granulomatous variety of pigmented purpuric dermatosis with negative Perl's stain ?

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Dr. Mona Abdel-Halim

Posted

First impression was PPD (granulomatous variant), but negative Perl's??

Looking carefully at the clinical images (with magnification), there appears to be a follicular nature of the lesions. The low power is showing that the infiltrate is circumscribed around ? hair follicle (as evidenced by arrector pili muscles). An out of the box thought: could it be lichen scrofulosorum??

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Admin_Dermpath

Posted

From Dr Chaudhry:

 

Dear All thank you. Clinically this fitted with Pigmented PPD. You need around 10 days for iron products/Perl's positivity to develop. So negative Perl's would not exclude the diagnosis
 
Couple of references
 
J Cutan Pathol 2011: 38: 979–983 - Persistent pigmented purpuric dermatitis: granulomatous variant
 
Acta Derm Venereol 93 (2013) Granulomatous Pigmented Purpuric Dermatitis Associated with Primary Sjögren’s Syndrome Chihiro Wakusawa, Taku Fujimura*, Takahiro Haga and Setsuya Aiba

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