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?

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Case Number : Case 2322 - 10 May 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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M15. Known ALL. Rash 6/12. Treated as scabies. Widespread papules all over including genital area

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Krishnakumar subramanian

Posted

pink pigtail structures, indicative of empty scabies eggshells

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Dr. Richard Carr

Posted

Thank you all.

I wanted to show the pigtails (empty egg shells) as the clue for Scabies. This was a case where initial sections showed a non-specific pattern of lichenification, mild spongiosis, perivascular lymphocytes and eosinophils. I requested levels through the blocks at 150 micron steps and found the nice pigtails and mite (in just one or two) of the step sections. It is always nice to give a specific diagnosis and given the clinical history I thought is was worth exhausting the tissue to find the suspected culprit that is very much alive. Not finding the mite or egg shells would not have excluded "active" scabies of course. Remember one can also suspect scabies from the faecal deposits in the burrow (brown blobs/golden nuggets).

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