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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 2373 - 26 July 2019 Posted By: Dr. Richard Carr

Please read the clinical history and view the images by clicking on them before you proffer your diagnosis.
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F45. 3 chronic erosive lesions on forearms. Underlying inflammation. History of ankylosing spondylitis on adalimumab. ?Sweets or EED. Patient concerned about Lyme disease. To r/o malignancy. Biopsy left tricep area across ulcer ?infection e.g. Staph. No response to topical sterioid. Name the IHC stain please.

Edited by Admin_Dermpath


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Anil Patki

Posted (edited)

Already posted earlier

Edited by Anil Patki

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Why IHC stain? Couldn't be quit enough just a Giemsa(for Leishmaniasis?)

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Krishnakumar subramanian

Posted

leishmaniasis

DD: Pencillium marneffi/ Histoplasma

PAS and GMS stain suggested

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Meenakshi Batrani

Posted

Lesihmaniasis, Histoplasmosis, Pencillium marneffei- need PAS and Giemsa

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Dr. Richard Carr

Posted

There should be an IHC stain. It is Leishmaniasis. Any idea what IHC stain I might have done?

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IHQ with anti-leishmania (they produce here in Brazil, I don't know if it's available outside) or anti-CD1a. Interestingly, CD1a works best for old-world species, species from Brazil and other new-world countries do not stain properly.

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Dr. Richard Carr

Posted

Well you can see it was CD1a. Not sure about the travel history for this patient. Patient's in UK get referred to one of the national centres and PCR's can be done on the tissue for species.

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It should be stressed that this positive result for leishmania with CD1a is observed when using the MTB1 clone.

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Krishnakumar subramanian

Posted

Thanks a lot for this information sir

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