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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 2631 - 06 August 2020 Posted By: Saleem Taibjee

Please read the clinical history and view the images by clicking on them before you proffer your diagnosis.
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77M, New sudden onset multiple small coalescing warty crusted papular lesions on back, flanks and under breasts.

Edited by Admin_Dermpath


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Richard Logan

Posted

Lovely histology and clinical pictures, Saleem.  The clinical distribution of the rash is that of Grover's disease, but it is extremely florid.  However, there are villi and corps ronds which is pushing me towards calling this a late manifestation of Darier's disease rather than Grover's.

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Krishnakumar subramanian

Posted

acantholytic dermatosis

Could be grover

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There´s a cleft in the granular layer best seen in picture 3 that favors Grover over Darier, histologically.

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19 hours ago, IgorSC said:

There´s a cleft in the granular layer best seen in picture 3 that favors Grover over Darier, histologically.

Interesting point. Thanks, Igor.

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Saleem Taibjee

Posted

Thanks. As we know Grover's has many histological variants including a Darier pattern, which as Richard points out is of acantholytic dyskeratosis with corp ronds (and grains) as evident in this case. The various histological patterns of Grover seems to be ever-expanding.

However, clinically I did not think this is such a good fit for Grover's. The lesions are especially widespread, the acantholytic process is broad and multifocal even within the same biopsy, and the warty morphology which our medical photographer has captured very well is particularly evident in the last image, and seems to better fit with Darier disease.

There are uncommon late presentations of Darier's. But I was particularly struck by the rather eruptive onset. This also reminded me of the sign of Leser-Trelat, in which eruptive seborrhoeic keratoses can be a harbinger of underlying malignancy.

After a brief literature search I have come across the occasional case report indicating a potential paraneoplastic manifestation (e.g. Gangopadhyay A, et al. Darier's disease in gastric malignancy: An unusual paraneoplastic phenomenon. Indian J Dermatol 2015;60(4):423).

Our patient  had previous Prostate cancer in 2015, T3a Gleason 3+4, and was taking Prostap (GnRH analogue) treatment. In view of the previous case reports we re-checked PSA and CT scan, but in the end there has been no evidence of recurrence thus far.

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