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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 2086 - 5 June 2018 Posted By: Uma Sundram

Please read the clinical history and view the images by clicking on them before you proffer your diagnosis.
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65 year old male with truncal rash and recent 20 pound (9 kg) weight loss.


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User Feedback


Interesting. Never heard of Galli Galli disease. Thank you.

What's about the clinical information:  recent 20 pound weight loss?

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Anil Patki

Posted

If the weight loss is an indication of malignancy, this acantholytic disorder could very well be paraneoplastic pemphigus.

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vincenzo polizzi

Posted

Completely agree with Anil. Paraneoplastic Pemphigus was my first spot. Oral mucosa?

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Raul Perret

Posted

Also thought of paraneoplastic pemphigus

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Anil Patki

Posted

If Vincenzo and Raul both agree, I heave a sigh of relief! :-). I know I am on the right path!

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John Zhang

Posted

My first thought was paraneoplastic pemphigus. The clue hinted a lot.

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vincenzo polizzi

Posted

Thanks Anil, but do not trust me so much. I’m an old general pathologist trying to learn a little dermatopathology. Anyway thanks. At my age like compliments even if you don’t deserve :-)

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Anil Patki

Posted

Vincenzo, I am an old clinician with great interest in and little knowledge of dermatopathology. You have spent many more hours looking through the microscope than me and definitely know more than me!

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Raul Perret

Posted

I hope one day I will have as much knowledge and passion as you guys show in this and other forums. Thanks Vincenzo and Anil for sharing your precious points of view.

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Uma Sundram

Posted

You all are wonderful to work with and I feel like I know you well :)

Thank you again for your passionate support of this forum. Yes, answer is paraneoplastic pemphigus. I like galli galli disease too (rare inherited disease of keratotic dysmaturation that has histologic overlap with the more hyperplastic lesions of pemphigus) but DIF in this case is positive (chicken wire intercellular pattern with IgG).  A separate serum sample (IIF) was submitted for both monkey esophagus and rat bladder assessment and both were positive. A systemic work up revealed DLBCL of the lymph node with pelvic lymph adenopathy; the patient had oral lesions as well.

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