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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 2782- 5 March 2021 Posted By: Richard Logan

Please read the clinical history and view the images by clicking on them before you proffer your diagnosis.
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M 25 Previous history of Hodgkin's disease treated with chemotherapy and radiotherapy. Four year history of pigmented rash on trunk. Biopsy from trunk.


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Admin_Dermpath

Posted

 

posted By vincenzo

?Pityriasis Rubra Pilaris

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Admin_Dermpath

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Posted By: Anil Patki

There's laminated hyperkeratosis, attenuated granular layer and follicular plugging with some pityrosporum spores in the follicle. PRP is a good suggestion by Vincenzo but I don't see any significant acanthosis. 

 This will need clinico-pathological correlation and the diagnosis will depend on clinical appearance of the lesions. 

 Since the lesions are pigmented, it's likely that it's acquired ichthyosis and pigmentation, both of which are paraneoplastic manifestations seen in patients with Hodgkin's lymphoma. 

 Investigations to rule out relapse of Hodgkin's may be needed in that case. 

 

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Alex-Ventura-Leon

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Pigmented lesion on trunk made me think in Confluent and Reticulated Papillomatosis (CARP) 

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Richard Logan

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7 hours ago, Alex-Ventura-Leon said:

Pigmented lesion on trunk made me think in Confluent and Reticulated Papillomatosis (CARP) 

Well done Alex, you are correct.  I will attach a clinical photo which shows the characteristic clinical appearance of confluent and reticulated papillomatosis seen in this case.  The histology shows the typical invagination of the epidermis by hyperkeratotic stratum corneum, and rather blunt-topped papillomatosis.  As Anil says, there are some follicular Pityrosporum yeasts but no ramifying hyphae as might be expected if this were Pityriasis versicolor.

DPP clinical 5.3.21.jpg

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