Case Number : Case 2847- 04 June 2021 Posted By: Dr. Richard Carr

Difficult for me. ? Neutrophilic eccrine hidradenitis, ?purpuric dermatosis ( but there are too pmn in dermal infiltrate ). Waiting for answer. 

some dermal perivascular eosinophils with basal cell vacuolar changes

? drug rash

The pattern is a subtle neutrophilic dermatosis with neutrophilic epitheliotropism (eccrine duct) = neutrophilic urticarial dermatosis. We can see a few colloid bodies but no eosinophils in these images. 

Can be a clue to many conditions but in this case I believe it was is adult onset Still's disease. Great references as follows....

https://pubmed.ncbi.nlm.nih.gov/26317390/

https://pubmed.ncbi.nlm.nih.gov/30224079/

sir, we can get neutrophils in acrosyringial ducts in  miliaria pustulosa too, how to exclude that and go for this rare diagnosis sir

Miliaria would be a highly unlikely diagnosis at this age.

understand sir, i read the 2 articles suggested by Dr Carr. It was wonderful. Just to trigger Dr Carr.. He could have suggested  a clue as urticarial rash

49 minutes ago, Krishnakumar subramanian said:

understand sir, i read the 2 articles suggested by Dr Carr. It was wonderful. Just to trigger Dr Carr.. He could have suggested  a clue as urticarial rash

Yes I could have been more helpful but for dermpathpro I expect more! and you usually deliver! I hope you won't now forget the pattern even though I was mean to you.

Thanks sir, shall improve