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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 2069 - 11 May 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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M90. Forearm. Multiple nodules on forearm ?metastases, ?gout

Edited by Admin_Dermpath


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Saman Fatah

Posted

Excellent quality clinical photographs of unilateral “cold abscesses” in someone with a probable RA.

Suppurative and granulomatous dermatitis with a probable dermal abscess.

An infective cause needs to be considered first through appropriate stains and triple tissue cultures. In the UK most of these cases is related to Non-Tubeculous Mycobacterial (NTM) infections especially Mycobacterium Chelonae. Usually the latter is isolated in those on immunosuppresives especially oral Prednisolone, CPC is essential including history of trauma/fish tank etc.

 

 

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Anil Patki

Posted

Chronic granulomatous inflammation either due to atypical mycobacterial infection or deep fungal infection.

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Admin_Dermpath

Posted

Please see final two images for an extra clue!

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Anil Patki

Posted

Solid staining acid fast bacilli. - M chelonae or M fortuitum infection.

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Dr. Richard Carr

Posted

Very well done and Saman in particular. I had not told you this patient was on prednisolone for bullous pemphigoid. This was also culture +ve for M. chelonae.

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Saman Fatah

Posted

Great case Richard and thanks for the feedback on final diagnosis.

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