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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 2784- 9 March 2021 Posted By: Iskander H. Chaudhry

Please read the clinical history and view the images by clicking on them before you proffer your diagnosis.
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45F , C and C left forearm. Inflamed lichenoid rash. Pus discharge and bleeding.


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Krishnakumar subramanian

Posted

was he on any therapy with anti-PD-1 medications. Looks like lichenoid dermatitis

 

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Richard Logan

Posted

The lichenoid infiltrate includes more plasma cells than might be expected for a "normal" lichenoid inflammatory pattern.  There is pigment in the dermis which I think might be tattoo rather than pigmentary incontinence of melanin. 

I think this may be an infective problem.  This includes the possibility of an atypical mycobacterium from infected tattoo material, and of course syphilis must be excluded, although the clinical details are not really suggestive of that.  Certainly the skin needs to be cultured for bacteria, atypical bacteria and fungi.

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Alex-Ventura-Leon

Posted

I also think that there is a exogenous pigment in some images.

So agree with Vincenzo: Lichenoid Tattoo reaction.

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Admin_Dermpath

Posted

Dr Chaudhry:

Thank you for your comments. The final diagnosis is tattoo-associated, pseudolymphomatous lymphoid reaction pattern

Saulite I, Pekar-Lukacs A, Kerl K, Cozzio A, Hoetzenecker W, Guenova E. Pseudolymphomatous Reaction to Red Tattoo Pigment. Case Rep Dermatol. 2018;10(2):162-168. Published 2018 Jun 14

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