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 2343 - 10 June 2019 Posted By: Limin Yu

Please read the clinical history and view the images by clicking on them before you proffer your diagnosis.
Submitted Date :
   (0 reviews)

12-year old, lesion on thigh


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Alice Roberts

Posted

Lichen striatus comes to mind. Not sure. Need more clinical.

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Anil Patki

Posted

Epidermal necrosis with underlying lymphocytic vasculitis. Malignant atrophic papulosis (Degos's disease) or drug induced vasculitis. Clinical correlation is needed

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Meenakshi Batrani

Posted

Epidermal necrosis with intact lichenoid superficial and deep infiltrate.  I can think of PLEVA. Other d/d could include drug, bite (although no eosinophils) and DLE. Need cpc.

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Alex-Ventura-Leon

Posted

Epidermal necrosis and wedge shape infiltrate of lymphocites. I favor PLEVA, but if the lesion is solitary could be a Insect Bite. CPC is needed

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I do not expect deep inflamatory infiltrate in PLEVA. At first glance, I thought about insect bite reaction, but I do not see eosinophils and mucin deposits. But I can see some intraepidermal lymphocytes in a crusted lesion and deep inflamatory infiltrate. Lymphomatoid papulosis is my best hypothesis.

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4 hours ago, IgorSC said:

I do not expect deep inflamatory infiltrate in PLEVA. At first glance, I thought about insect bite reaction, but I do not see eosinophils and mucin deposits. But I can see some intraepidermal lymphocytes in a crusted lesion and deep inflamatory infiltrate. Lymphomatoid papulosis is my best hypothesis.

Agree! I didn't see the intraepidermal lymphocytes with clear halo, before...So a type B LyP could be a good differential.

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John Zhang

Posted

Thanks for the great dicussions above! My initial thoughts were PLEVA vs. bite vs. equestrian perniosis. I agree Lyp needs to be ruled out. 

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Dr. Richard Carr

Posted

Equestrian perniosis was my favoured but good suggesions above. Shame Limin gave up responding!

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