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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 2770 - 17 February 2021 Posted By: Dr. Hafeez Diwan

Please read the clinical history and view the images by clicking on them before you proffer your diagnosis.
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38-year-old female ICU patient with biopsy of rash on left arm.


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Richard Logan

Posted

I am assuming that the blue staining in the dermis is artefactual via the split in the epidermis.

The epidermis shows pigmentation which is probably constitutional.  There is a degree of predominantly parakeratotic hyperkeratosis.  Beneath this there is patchy pallor affecting the uppermost cells of the Malpigian layer, and a mild perivascular inflammatory infiltrate with vascular dilation.

I would consider nutritional deficiency such as pellagra, zinc deficiency or the early stages of necrolytic migratory erythema.

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Alex-Ventura-Leon

Posted

2 hours ago, Richard Logan said:

I am assuming that the blue staining in the dermis is artefactual via the split in the epidermis.

The epidermis shows pigmentation which is probably constitutional.  There is a degree of predominantly parakeratotic hyperkeratosis.  Beneath this there is patchy pallor affecting the uppermost cells of the Malpigian layer, and a mild perivascular inflammatory infiltrate with vascular dilation.

I would consider nutritional deficiency such as pellagra, zinc deficiency or the early stages of necrolytic migratory erythema.

Agree. I thinking in Nutritional deficiency too

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I didn’t get there alone, but agree with above. 

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Dr. Hafeez Diwan

Posted

Sorry for the delayed response.  Patient is COVID-19 negative.  Nutritional deficiency.

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