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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 2351 - 20 June 2019 Posted By: Dr. Richard Carr

Please read the clinical history and view the images by clicking on them before you proffer your diagnosis.
Submitted Date :
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M55. Sri Lankan. >1 year asymptomatic, non-tender, firm, dark discolouration to both lower legs. Rt > Lt.
?Erythema nodosum clinically. No resolution over 9/12. Denies joint pains, swellings, other rashes, weight loss. Dermatologist queries pretibial myxoedema ?scleroderma, ?deep lupus / panniculitis

Edited by Admin_Dermpath


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Hemorragy is a common event in Erythema Nodosum, as the lipomembranous fat necrosis. So my provisional spot is EN.

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Krishnakumar subramanian

Posted

stasis with septal panniculitis and fibrosis

something like lipodermatofibrosis

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John Zhang

Posted

My first impression was lipodermatosclerosis. The hemosiderin in fig 3 seems too superficial for EN.

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Dr. Richard Carr

Posted

Think we're missing some images. I'll enquire.

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On 19/06/2019 at 21:08, Krishnakumar subramanian said:

stasis with septal panniculitis and fibrosis

something like lipodermatofibrosis

Agree. I would like to see more lobular inflammation/adipocytic necrosis, but I think this is the best diagnosis.

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Erythema nodosum is usually tender or painful, so may be I'm wrong...

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Neil Catterall

Posted

Lipodermatosclerosis with membranocystic change 

 

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Lipodermatosclerosis and venous insufficiency 

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Dr. Richard Carr

Posted

Yes I agree with prominent haemosiderin deposition, minimal inflammatory changes, focal lipomembranous fat necrosis in keeping with venous insufficiency and lipodermatosclerosis. I suspect increased basal melanin pigmentation may also be contributing to the clinical appearances.

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