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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 2944 - 19 October 2021 Posted By: Uma Sundram

Please read the clinical history and view the images by clicking on them before you proffer your diagnosis.
Submitted Date :
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"34 year old female with chronic alcoholism with new, progressive large bruise like areas over the
bilateral thighs and flanks."


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User Feedback


Victor Delgado

Posted

There are some vasculitis changes in the subcutis with fibrinoid necrosis and RBCs extravasation. Is a young woman with alcohol abuse, may be we should ask about cocaine use. Cocaine related retiform purpura.

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Richard Logan

Posted

The epidermal changes of patchy parakeratosis, slight upper epidermal pallor and vacuolation suggest a nutritional deficiency which might be expected with the clinical history of alcoholism.

The appearances in the fat are difficult to interpret as the slide is overexposed. There appears to be congestion in the lobular capillaries with some red cell extravasation.  This makes me wonder about co-existent scurvy.

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The last two pictures show fat necrosis. I wonder whether it's pancreatic panniculitis due to pancreatitis developing in a chronic alcoholic patient 

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Meenakshi Batrani

Posted

Last two images are not clear but seems like thrombotic vasculopathy. The dermal and epidermal changes might be secondary to occlusive vasculopathy.

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The epidermal changes suggest an acrodermatitis enteropatia secondary to alcoholism, as Richard said. The subcutaneous fibrinoid(?) vasculopathy could be a porphiria-like occurrence. 

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Uma Sundram

Posted

Great suggestions. She had a developing vasculopathy which caused extensive necrosis. We considered calciphylaxis as she had some scattered vascular calcification, but her kidney function was normal. Apologies for delay in posting; there was something wrong with my ability to access the website. I think it's fixed now.

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