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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 2431 - 25 October 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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Male Adult. Forearm. Spot diagnosis c/o Dr Neil Catterall


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Krishnakumar subramanian

Posted

deep fungal infection

 ? Blastomycosis

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Budding yeast...I would agree with Krishnakumar. I'm not familiar with these infections.

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Dr. Richard Carr

Posted

I've ask for another image to be posted.

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Krishnakumar subramanian

Posted

sir usually we depend on culture or sequencing data to know the fungus type. if it is not the usual deep fungus which we see routinely

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Dr. Richard Carr

Posted

There is a nice x40 image with a clue. Hopefully it will get posted.

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The fungus shows narrow based budding. I think it's paracoccidiodomycosis. 

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Yes. Asteroid body. Agree with Sporotrichosis.

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Dr. Richard Carr

Posted

Yes this is a wonderful case of sporotrichosis (a big absenteee from my slide collection and personal experience). Neil Catterall was kind enough bring a case over when he visited earlier this year (in response to my plea to have a case 1745 3 Feb 2017)  - and this is the first time it has been seen on Spot Diagnosis!!! There were very few organisms (despite 4 large TS from a generous skin biopsy) and as you can see they are in the centre of pustulating granulomas. I do remember reading in Weedon many moons ago it was one of the few indications for serial sections on a biopsy (to find the asteroid body in the centre of a pustulating granuloma. This case also has rather strking follicular pseudoepitheliomatous hyperplasia. 

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Krishnakumar subramanian

Posted

Thanks for the points shared sir

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