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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 2811- 15 April 2021 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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5y.o. girl, 1 year history of itchy papules on erythematous urticated base with vesicles


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Saman Fatah

Posted (edited)

Eosinophils-rich dermal inflammation extending deep to perieccrine and subcutaneous regions with flame figures. Epidermis is unremarkable other than the focal changes centrally which could be a clue to something at further sections.

When correlated with the available clinical features, it could be an arthropod assault/papular urticaria Vs infestation (scabies). It will be a bit unusual if it was a latter and no one else in the family not infested by now (one year) but exceptions happens. 

Are the papules evolves to annular or arcuade plaques with progress of time?

Other histological DDx include Well syndrome/Eosinophilic Annular Erythema spectrum pending CPC.

 

Edited by Saman Fatah
Missing word (could)

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Krishnakumar subramanian

Posted

spongiotic vesicles, with dermal eosinophils and flame figures

rule out Insect bite reactions

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Richard Logan

Posted

I agree with the diagnoses suggested above.  Perhaps the epidermal disruption makes insect bite reaction the most likely diagnosis.

From a histological perspective I would also add Churg-Strauss syndrome into the differential diagnosis, although of course that condition is more usually seen in middle-aged adults.

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vincenzo

Posted

?Scabies. Agree with Colleagues. Further sections needed. 

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Victor Delgado

Posted

Bite reaction

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Saleem Taibjee

Posted

Yes, well done, the clinician was querying insect bite reaction / papular urticaria.

I included this case as a particularly nice example of flame figures. Saman has provided a comprehensive differential diagnosis.

BW
Saleem

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tyelaine

Posted

Nice illustrative case!

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Yousra

Posted

Insect bite reaction

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