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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 4004 - 26 May 2022 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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"6-year-old boy, punch biopsy, ulcerated lesion left cheek"


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vincenzo

Posted

I was thinking of primary syphilis..., before reading clinical history...I don’t know.  I think CPC is mandatory here,  ton rule out infectious diseases like fungus, tbc, ....

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Shawn

Posted

Granulomatous/histiocytic inflammation, wide differential. I also wonder if malakoplakia is a possibility

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Anil Patki

Posted

Lesion with granulomatous inflammation on the cheek of a boy raises several possibilities. Idiopathic facial aseptic granuloma  is a possibility if it's a single nodule. Borderline tuberculoid leprosy with a severe type 1 reaction can lead to ulceration as can lupus vulgaris. We do not know if the boy comes from leprosy endemic area. Stains for acid fast bacilli and PCR for mycobacterial antigens may lead to the diagnosis. Granulomatous rosacea (IFAG may be a variant of it) may also be considered depending on the clinical features. Ulceration favours mycobacterial etiology.

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Saleem Taibjee

Posted

Hi. This recent case depended upon PCR. Despite careful scrutiny of the H&E (in particular the granulomatous area directly beneath the epidermis), I could not identify organisms. However, PCR confirmed Leishmania tropica. The patient had travelled to an endemic area.

BW
Saleem

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