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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 2220 - 12 December 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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37F. Incision biopsy right abdomen.


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Krishnakumar subramanian

Posted

acantholytic bulla -pemphigus foliaceous/vulgaris

However there is intense dermal inflammation look for associated castle mans disease

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Alex-Ventura-Leon

Posted

Could be a Pemphigus Vulgaris whit re-epithelialization?

Agree that the dermal inflamation probably is a clue for something else.

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Uma Sundram

Posted

What about a solitary lesion like acantholytic acanthoma? It seems odd to do an incisional biopsy on a rash. It's super hard without a more defined clinical picture.

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Dr Iskander, what's the 2204 case's diagnosis, please?

Agree with Uma's comment: my first spot is something like Warty Dyskeratoma. I don't know difference between acantholytic acanthoma and warty dyskeratoma. WD could have a multi follicular origin...  

 

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Dr. Richard Carr

Posted

Agree acantholytic acanthoma is a good suggestion. CPC obviously.

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Iskander H. Chaudhry

Posted

Dear all this was an unusual case as this is the only history we were given - I suggested if solitary acantholytic acanthoma but if more widespread blistering eruption then consider pemphigus and other suprabasal acantholytic disorders. Subsequent direct  immunofluorescence confirmed pemphigus vulgaris and clinician also confirmed more widespread eruption! 

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