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 2381 - 14 August 2019 Posted By: Arti Bakshi

Please read the clinical history and view the images by clicking on them before you proffer your diagnosis.
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51/M. 12 month h/o progressive skin nodules - elbows, knees and legs; associated petechial rash on flexural aspect of upper limb.

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A palisaded histiocytic granulomatous proliferation, with many neutrophils, nuclear dust and piecemeal basophilic collagen degradation, makes me think of a Palisaded Neutrophilic Granulomatous Dermatitis.

This is a dark grey pathological area for me, because  I haven't yet understood the clinical-pathological diff between PNGD and interstitial granulomatous dermatitis...

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agree with Vincenzo. it is a pattern of PNGD, also called "Winkleman granuloma" (Cutaneous extravascular necrotizing granuloma). associated with RA and other systemic disorders.

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