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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 2185 - 24 October 2018 Posted By: Dr. Hafeez Diwan

Please read the clinical history and view the images by clicking on them before you proffer your diagnosis.
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23 year-old female with 2 month history of multiple red nodules on right forearm.


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At first glance, the history of multiple red nodules plus the inflammatory infiltrate, mucin and eosinophils made me think about persistent insect bite reacion. But then I saw within this dense dermal inflammatory infiltrate composed of lymphoid cells and eosinophils, some vessels with proeminent endothelia. Despite not been so common the presentation of multiple nodules, I think this is a case of ALHE (epithelioid hemangioma).

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Alex-Ventura-Leon

Posted

I favor persistent insect bite reaction.

Nice suggestion about ALHE but for me it wolud be ver unusual.

Waiting for the final answer.

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There are three distinctive features: 1) EOSINOPHILIC VASCULITIS, 2) DERMAL PROMINENT MUCIN 3) some interface vacuolar dermatitis. Recurrent Cutaneous Eosinophilic Vasculitis could be an option. Insect bite is another good spot. But I favor an eosinophilic vasculitis in a probably systemic Lupus. 

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Dr. Hafeez Diwan

Posted

I ended up calling this angiolymphoid hyperplasia with eosinophilia.

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