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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 2292 - 27 March 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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55 year-old male with biopsy of right dorsal hand


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John Zhang

Posted

Subepidermal paucicellular vesicular dermatitis with post-inflammatory hyperpigmentation. There are also scattered necrotic keratinocytes. Differential diagnosis includes porphyria, cell poor BP, EBA, erythema multiforme and fixed drug eruption. I kind of favor porphyria because of the paucicellular nature, the caterpillar bodies and the location of dorsal hand. With DIF and clinical correlation the diagnosis should be more obvious.

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Krishnakumar subramanian

Posted

cell poor sub epidermal bulla

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Anil Patki

Posted

Fixed drug eruption is the first thing that comes to my mind. Inherited porphyria is unlikely as at the age of 55, the patient will have a lot of scarring in the dermis because of recurring blisters. Other possibilities are cell-poor pemphigoid and pseudoporphyria induced by photosensitizing drugs like frusimide. 

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Thought the same as John. Porphyria Cutanea Tarda. 

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Alex-Ventura-Leon

Posted

Agree with the excelents differentials, but i favor Fixed Drug Eruption

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21 hours ago, John Zhang said:

Subepidermal paucicellular vesicular dermatitis with post-inflammatory hyperpigmentation. There are also scattered necrotic keratinocytes. Differential diagnosis includes porphyria, cell poor BP, EBA, erythema multiforme and fixed drug eruption. I kind of favor porphyria because of the paucicellular nature, the caterpillar bodies and the location of dorsal hand. With DIF and clinical correlation the diagnosis should be more obvious.

 well said, agree with PCT, need DIF.

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Dr. Hafeez Diwan

Posted

Fixed drug eruption.  This is what they were thinking clinically as well.

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Dr. Mona Abdel-Halim

Posted

Beautiful images. It is definitely a setting were CPC is mandatory.

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