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In this section we have spot diagnoses posted on a daily basis since June 2010, now over 4000! You can review the archived cases and read the suggested diagnoses by users and the final comment by the contributors.
Case are uploaded each week day by 10 am UK time with the correct diagnosis will generally be posted at 8 pm 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.
Submitted Date :
   (0 reviews)
55 year old female: Clinically capillaritis last biopsy.
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Anil Patki

Anil Patki 4

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

vincenzo polizzi 185

Posted

What about a morbilliform expression of hemophagocytic LymphoHistiocytosis?

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Admin_Dermpath

Admin_Dermpath 1,211

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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Anil Patki

Anil Patki 4

Posted

Hemosiderin may be absent in early lesions. 

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Dr. Mona Abdel-Halim

Dr. Mona Abdel-Halim 508

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

Admin_Dermpath 1,211

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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