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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 2861 - 24 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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5 year old boy with widespread painful blistering rash


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daniellindsay

Posted

Appears to be intraepidermal separation at level of the granular layer. Would consider a staphylococcal scalded skin syndrome. 

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vincenzo

Posted

Subcorneal separation of cells, coagulative necrosis in the superior epidermis with dyskeratosis resembling pemphigus foliaceus, epidermal nuclear elongation and streaming, pyknotic tightly packed epidermal nuclei, dark staining of epidermal nuclei, homogenization of dermal collagen..thinking of some external traumatic agent, like burns...

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Krishnakumar subramanian

Posted

superficial epidermal split. No inflammation. No epidermal necrosis and no dermmal inflamation

-staphylococcal scalded skin syndrome. 

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Victor Delgado

Posted

Pemphigus Foliaceus

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Richard Logan

Posted

2 hours ago, Victor Delgado said:

Pemphigus Foliaceus

Histologically yes, but pemphigus is virtually unheard of in this age group.  I agree with SSSS.

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Eman El-Nabarawy

Posted

SSSS.

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Saleem Taibjee

Posted

Yes, well done. This was a recent case in which the suggested clinical diagnosis was Staphylococcal scalded skin syndrome. I haven't seen many examples of this histologically because it tends to be a clinical diagnosis and only rarely biopsied, and of course more common in children. In adults it is sometimes seen in the context of patients who are immunosuppressed or have renal impairment (which may impair clearance of the circulating toxin).

I have submitted this case to illustrate it as a nice example of the Floating (or absent) stratum corneum sign (see below). This is an important histological clue to a superficial (acantholytic) blistering process, and may be encountered in SSSS, bullous impetigo as well as pemphigus foliaceous.

BW

Saleem

floating stratum corneum sign.jpg

 

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Yousra

Posted

SSSS, subcorneal separation and no significant eosinophilic or neutrophilic infiltrate, together with the history favor it 

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HENRY

Posted

Such a beautiful case!

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