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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 2391 - 29 August 2019 Posted By: Limin Yu

Please read the clinical history and view the images by clicking on them before you proffer your diagnosis.
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76 M arm


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Meenakshi Batrani

Posted

Seem to be Gram positive and weakly acid fast positive filamentous bacteria. The staining characteristic fits with Nocardia, which may cause three varieties of cutaneous infections: Mycetoma like, lymphocutanoues/sporotrichoid and abcess or cellulitis. In the images, I don't see it forming a distinctive grain to call it mycetoma. But it could be either sporotrichoid or abcess. 

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Anil Patki

Posted

Atypical mycobacterial infection is another possibility. Is the patient immunocompromised?

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Alex-Ventura-Leon

Posted

Filamentous bacteria acid fast positive surounded by dense neutrophilic inflammation.

My first thought is Nocardia

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