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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 2370 - 22 July 2019 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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60 year old male with rash on his back. He has been admitted with his fourth episode of acute renal failure.

Edited by Admin_Dermpath


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Acantholytic suprabasal disorder, with many round corps and grains, and other findings that recall Darier Disease. But some pseudo-cobblestone pattern, pemphigus vulgarisms-like, should be more in keeping with Grover's disease.

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Krishnakumar subramanian

Posted

patient has renal failure and he has a supra basal acantholytic bulla. there is layer of epidermal necrosis. there are some corps and grains. there is dermal inflammation. why there is epidermal necrosis I wonder. these things I have not seen in hailey Hailey or grovers disease

if sub epidermal bulla then epidermolysis bulls acquisitor or porphyria etc would be my line of thoughts

I would like to have DIF results before concluding. 

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Meenakshi Batrani

Posted

Acantholysis with dyskeratosis. In view of older age and renal failure, I would consider Grover's disease. There have been some reports of Grover's disease associated with chronic renal failure and dialysis. DIF study needed to exclude pemphigus.

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I tjink the diagnosis is between Darier disease and Grover disease. The histopathologic pictures are more consistent with Grover disease, as we can see different morphologic spectros like pemphigus-like and Darier-like epidermal alterations. The association of Grover disease with kidney disease is more present with chronic renal failure, not acute, and despite some pappers linking them both, I suspect that this could be more consistent with the usually more advanced age of this population. In contrast, Darier disease is caused by mutations in a cellular calcuim transporter and these patients can present with renal diseases strongly associated with Darier disease. Well, this doesn´t answer the question of wich disease is this. Particularly, I would call the clinician and ask for the clinical distribution of the lesions, looking for nail diseases, axilar, etc...

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