Case Number : Case 2993 - 27 December 2021 Posted By: Dr. Mona Abdel-Halim

Dyskeratotic cells in the upper epidermis and eosinophils in the dermal infiltrate catch the eye. Drug induced flagellate erythema and adult onset Still's disease are the main differentials.

Dyskeratotic cells in adult onset stills disease are limited to the upper layers of the epidermis and horny layer and are devoid of inflammatory infiltrates. In contrast to adult onset stills disease, the histology of dermatomyositis, drug eruption, and GVHD demonstrates dyskeratotic cells in all layers of the epidermis accompanied by inflammatory infiltrates

Dyskeratotic cells in persistent pruritic skin lesions as a prognostic factor in adult-onset Still disease.

Maeda-Aoyama N, Hamada-Ode K, Taniguchi Y, Nishikawa H, Arii K, Nakajima K, Fujimoto S, Terada Y.Medicine (Baltimore). 2020 Feb;99(6):e19051. doi: 10.1097/MD.0000000000019051.PMID: 32028422 Free PMC article.

Great case for learning and fantastic histology  images, thanks a lot madam

Agree with adult onset Still's disease. 

CPC would fit adult onset of Still’s disease, but too many eos in dermis, and too much disseminated and confluent dyskeratosis; so favor something like bleomycin induced flagellate erythema.  

Please Mona. What’s the 2983 Dx?

This was flagellate erythema of adult onset Still's disease.