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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 2856- 17 June 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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43M, erythematous rash on both arms and legs


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Krishnakumar subramanian

Posted

sections show epidermis and dermis. Epidermis looks normal. In the superficial dermis there is some condensation of collagen. There are scattered vessels. there is no vascular damage, however there seems to be some thickening around the vessels. thee is minimal dermal inflammation with lymphocytes around the mid dermal vessels

can we have a PAs stain, we need to exclude Cutaneous collagenous vasculopathy 

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vincenzo

Posted

I see a thrombotic vasculopathy in right part of first 3 pictures and in 4right part of 5th picture. I don’t know what this is. ??Covid

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Meenakshi Batrani

Posted

Vessels are dilated and have thickened wall. PAS stain will help to delineate if it is collagenous vasculopathy. 

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vincenzo

Posted

I didn’t know this entity, but now I’ve studied and really believe my Colleagues are right: cutaneous collagenous vasculopathy. Thanks for this interesting case. 

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Richard Logan

Posted

36 minutes ago, vincenzo said:

I didn’t know this entity, but now I’ve studied and really believe my Colleagues are right: cutaneous collagenous vasculopathy. Thanks for this interesting case. 

I agree with Vincenzo and colleagues.  This entity is new to me too.

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volha

Posted

Looks like cutaneous collagenous vasculopathy, PAS will be useful 

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Saleem Taibjee

Posted

Looks like you are on the right track... Here is the PAS below:

19528_20.0x PAS b.jpg

19528_40.0x PAS c.jpg

19528_20.0x PAS.jpg

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Richard Logan

Posted (edited)

I have a short memory.  There was a previous case (1634) of this condition posted on 29th September 2016.  The current case shows the features better, especially with PAS.

Edited by Richard Logan
Added information

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Saleem Taibjee

Posted

Yes, well done, this is a recent case of cutaneous collagenous vasculopathy. I hadn't seen a case for years until this case came by recently. I nearly missed it until noting the telangiectatic vessels towards one side of the biopsy in the absence of any other obvious pathology, and then scrutinising at higher power.

It is an intriguing histology, and even after briefly reviewing the more recent literature, it still seems to be a rather enigmatic condition. Many cases present with clinical similarity to generalised essential telangiectasia with slowly progressing telangiectasia starting on the lower legs, suggesting it is worthwhile biopsying such cases. Reading some recent papers, there are a few theories, including a form of reparative vascular proliferation. I can see one recent paper reporting an association with prothrombin G20210A thrombophilia. I would not be surprised if there is a genetic predisposition.

BW
Saleem

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