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In this section we have spot diagnoses posted on a daily basis since June 2010, now over 4000! You can review the archived cases and read the suggested diagnoses by users and the final comment by the contributors.
Case are uploaded each week day by 10 am UK time with the correct diagnosis will generally be posted at 8 pm UK time. Why not view the most recent spot diagnosis and proffer a diagnosis?

Case Number : Case 4029 - 30June 2022 Posted By: Saleem Taibjee

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"44F Punch biopsy right lower leg: 5 month history ?lipoma ?erythema nodosum"


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Krishnakumar subramanian

Posted

tuberculoid  type-granulomatous inflammation in ADIPOSE TISSUE

is it anterior or posterior portion of leg

unilateral or bilateral

 

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Anil Patki

Posted

Lobular panniculitis with granulomatous inflammation and vasculitis suggest erythema induratum (nodular vasculitis). A search for latent/overt tuberculosis is warranted as is PCR for mycobacterial antigens. There are two types of erythema induratum - one associated with TB and the other is not.

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Agree with above granulomatous inflammation and vasculitis (modular vasculitis)

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vincenzo

Posted

On 30/06/2022 at 07:04, Anil Patki said:

Lobular panniculitis with granulomatous inflammation and vasculitis suggest erythema induratum (nodular vasculitis). A search for latent/overt tuberculosis is warranted as is PCR for mycobacterial antigens. There are two types of erythema induratum - one associated with TB and the other is not.

Agree!!!

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Saleem Taibjee

Posted

I find panniculitis a challenging area.

On this particular recent case I received this very helpful expert opinion from Luis Requena, who is the authority on panniculitis.

"I agree with your diagnosis of a mostly lobular panniculitis. The lesion consists mostly of a granulomatous panniculitis, an evolved lesion in which a specific diagnosis cannot be rendered. It could be erythema induratum, but many evolved lobular panniculitis may also show this histopathologic pattern."

 

BW, Saleem

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