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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 2446 - 18 November 2019 Posted By: Uma Sundram

Please read the clinical history and view the images by clicking on them before you proffer your diagnosis.
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95 year old female, in patient, with new bullae on the legs. An excoriated lesion is biopsied.


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Krishnakumar subramanian

Posted

subepidermal bulla with dermal perivascular eosinophils and lymphocytes

? IBA

bulla with sparse cells

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I´m not sure if those cells are mast cells. If so this could be a bullous mastocytosis. CD117 or a giemsa could be of some help.

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A blistering manifestation in elderly people, with excoriation ( by scratching? ) and pustular infiltrate...are the cells in dermoepidermal junction ( fig 2 ) eosinophils? If yes it could be a Bullous pemphigoid...

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If the patient is diabetic, this could be bullosis diabeticorum. It could be a simple friction blister which easily develops in this age. Immunofluoroscence study to rule out any immunobullous disorder is necessary. 

 

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Uma Sundram

Posted

This is a difficult case because the excoriation/necrosis is so dominating that it's easy to miss the eosinophils at the periphery. Also, the clinician biopsied an older lesion. But, C3 and IgG were positive, linear, and in the clinical context, the findings fit the diagnosis of bullous pemphigoid. Fig 2 cells are indeed eosinophils. The positive DIF addresses Igor's comment.

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