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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 2940 - 13 October 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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25M. Punch biopsy– 6 month history of lesion upper lip. HIV positive


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vincenzo

Posted

I’m seeing spores but not hyphae. Am I not?

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Meenakshi Batrani

Posted (edited)

Was quick to guess Candidiasis initially, with yeast like form and h/o immunosuppression, but seeing the case again, it is not because there are no pseudohyphae or neutrophils. Seem like Pityrosporum sp. Agree with a possibility of seborrhoeic dermatitis, but lip lesion as clinical history does not fits well. Need PAS and CPC. 

Edited by Meenakshi Batrani

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I suspect could be seb derm - shouldering parakeratosis. can be due to yeast and fungal stains would be helpful 

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Anil Patki

Posted

Seborrhoeic dermatitis or tinea versicolour depending on clinical picture.

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Saleem Taibjee

Posted

I thought this was also seborrhoeic dermatitis. I think the case is interesting because we have clear evidence of numerous yeast spores (see PAS below), and this is the first time I have seen histology to support the old hypothesis that seborrhoeic dermatitis may represent a hypersensitivity reaction to Malassezia furfur. I have also personally seen occasional cases which clinically showed a dramatic response to oral antifungal treatment, but those cases were not biopsied.

Of course, the case is also interesting because recalcitrant or widespread seb derm can be be an important clue to underlying HIV, although this information was already known and provided in this case. I don't have access to clinical images or further information in this case. However, I don't think it fits well for tinea versicolor based on the clinical information provided. I have also inferred that this is not Candida because it seems to be cutaneous lip rather than mucosal. However, I must admit that I am no expert on yeast morphology histologically.

BW, Saleem

49702_63.0x PAS.jpg

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