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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 2918 - 13 September 2021 Posted By: Dr. Mona Abdel-Halim

Please read the clinical history and view the images by clicking on them before you proffer your diagnosis.
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F 35
Long-standing history of recurrent fever, arthritis, body aches and skin lesions. She has been diagnosed previously as Still’s disease. She presented with widespread tender papules, nodules involving the face, trunk and extremities.


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Anil Patki

Posted

Lepromatous leprosy with type 2 lepra reaction (erythema nodosum leprosum)

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Richard Logan

Posted

Agree with lepromatous leprosy.  Is it legitimate to call it ENL when we don't see any evidence of panniculitis (although, of course it may be there)?

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Anil Patki

Posted

ENL is basically an immune complex disease mediated by deposition of antigen-antibody complexes and infiltration of regressing lepromatous foamy cell granulomas by neutrophils. Panniculitis is a rare finding in ENL as the granulomas are mainly in the dermis. 

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Richard Logan

Posted

3 hours ago, Anil Patki said:

ENL is basically an immune complex disease mediated by deposition of antigen-antibody complexes and infiltration of regressing lepromatous foamy cell granulomas by neutrophils. Panniculitis is a rare finding in ENL as the granulomas are mainly in the dermis. 

So the "Erythema Nodosum" appellation in this context is more a clinical description (red lumps) rather than the conventional pathological entity which, of course, is a form of panniculitis?

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Anil Patki

Posted

Yes, ENL differs fron EN clinically as well. In ENL, the lesions are extensive and evanescent. 

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Richard Logan

Posted

5 hours ago, Anil Patki said:

Yes, ENL differs fron EN clinically as well. In ENL, the lesions are extensive and evanescent. 

Thanks Anil.

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Dr. Mona Abdel-Halim

Posted

Well done! This was a case of ENL.

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