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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 2009 - 16 Feb 2018 Posted By: Dr. Richard Carr

Please read the clinical history and view the images by clicking on them before you proffer your diagnosis.
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RAC7813

F50. Very odd looking skin lesion for five months, fluctuates in size, could

it be infectious? DDx: Inflammatory lesion, ??atypical infection.

Edited by Admin_Dermpath


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The salient features are pseudoepitheliomatous hyperplasia and suppurative granulomatous inflammation. The 'odd' look suggests that it could be blastomycosis-like pyoderma. Other differentials are of course deep fungal infection, atypical mycobacterial infection, halogenoderma and superficial granulomatous pyoderma gangrenosum. Culture from the discharge, PAS stain and Fite Faraco for AFB may clarify further

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vincenzo polizzi

Posted

Vegetative pyoderma gangrenosum was my first spot. 

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Dr. Richard Carr

Posted

Further information: Site is leg. Additional history information. On long term steroids for Crohn's disease.

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Mycobacterium chalonae/abscessus infection likely as the patient is immunocompromised.

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Dr. Richard Carr

Posted

Yes you nailed it. M. Chelonae on culture. The original reporting pathologist did not see the suppurative granulomatous aspect and did not do special stains. I was asked to review it following positive culture. Remember the histopathology of so-called superficial granulomatous pyoderma (pyoderma gangrenosum variant) can look histologically similar but would not generally be favoured when you know the patient is on steroids already!

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