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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 2375 - 31 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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13 year-old female with 18-20 month history of left forearm nodule, slowly increasing in size.


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Anil Patki

Posted

Angiolymphoid hyperplasia with eosinophils

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Krishnakumar subramanian

Posted

I am impressed with epidermal changes with psudoepitheliomatous changes with foci of parakeratoticcolumn with inflammatory cells and somewhat like some trans epidermal elimination is happening. second point there is pan dermal inflammation with inflammatory cells close to the epidermis dermal junction

there is mixed inflammatory cells with histiocytes/lymphocytes and eosinophils and blood vessels

possibility

? tick bite granulomatous inflammation

are there remissions and recurrence-think of LyP

get Cd30 IHC it may be positive in both tick bite and LyP

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Krishnakumar subramanian

Posted

Get CD1a too considering the young age

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Dr. Hafeez Diwan

Posted

Angiolymphoid hyperplasia with eosinophilia.

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Victor Delgado

Posted

I like insect bite too, forearm isn't the commonest site for ALHE, ulceration and wedge shaped doesn't fit as well; although those blood vessels with endothelial swelling, cross to my mind ALHE.

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Krishnakumar subramanian

Posted

just for discussion endothelial cells could be also swollen in insect bite reaction

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On 01/08/2019 at 05:50, Victor Delgado said:

I like insect bite too, forearm isn't the commonest site for ALHE, ulceration and wedge shaped doesn't fit as well; although those blood vessels with endothelial swelling, cross to my mind ALHE.

Agree completely

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