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 2305 - 15 April 2019 Posted By: Limin Yu

Please read the clinical history and view the images by clicking on them before you proffer your diagnosis.
Submitted Date :
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M77. Right foot.


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Krishnakumar subramanian

Posted

granulomatous inflammation with necrosis

special stains for MTB/fungus needed

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Anil Patki

Posted

This looks like a perforating dermatosis with acanthosis around a transepidermal elimination canal. What is being eliminated from the dermis maybe altered collagen or mucin. I favour perforating papular mucinosis. 

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Meenakshi Batrani

Posted

Appears to be perforating necrobiotic granulomas: Deep GA, Rheumatoid nodule. Will also perform Fite for atypical mycobacterial infection. 

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vincenzo

Posted

Looks like a cat scratch disease...but in this site should be very odd.

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IgorSC

Posted

I think the kind of necrobiosis is more like the "fibrinoid-type". The granulomas also came from the deep of the biopsy, so I believe this is perforating rheumatoid nodule.

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John Zhang

Posted

Agree with many of the above comment. Neutrophils in the necrobiotic areas, would first rule out infections. If stains and cultures are negative, then deep GA or rheumatoid nodule.

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Alex-Ventura-Leon

Posted

Great differentials and agree it seems more fibrinoid (at least to my eyes). Definitively I would perform special stains and if these are negatives I favor Rheumatoid nodule over GA.

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vincenzo

Posted

10 hours ago, John Zhang said:

Agree with many of the above comment. Neutrophils in the necrobiotic areas, would first rule out infections. If stains and cultures are negative, then deep GA or rheumatoid nodule.

 

 

10 hours ago, IgorSC said:

I think the kind of necrobiosis is more like the "fibrinoid-type". The granulomas also came from the deep of the biopsy, so I believe this is perforating rheumatoid nodule.

Agree with both. The appearance is infectious but it could really be a reumatoidi nodule.  

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dermpath1

Posted

Can we add epitheloid sarcom to the differential?

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Dr. Mona Abdel Halim

Posted

Perforating rheumatoid nodule is my first thought. Epithelioid sarcoma to be R/O but cells do not look atypical from this power

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Krishnakumar subramanian

Posted

sir whats the final diagnosis

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Dr. Richard Carr

Posted

Looks palisaded granulomatous and necrobiotic. I would go for rheumatoid (or pseudorheumatoid / deep GA nodule). 

 

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