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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 4613 - 29 March 2025 Posted By: Admin_Dermpath

Please read the clinical history and view the images by clicking on them before you proffer your diagnosis.
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A 21-year-old male presented with a 2-year history of multiple brownish skin lesions over the face, neck, both axillae, both upper limbs, both popliteal fossae, and both flanks, with aggregation on the flanks over the last 4 months. Examination revealed multiple confluent necrotic macules and papules over the face, auricular area, axillae, inguinal regions, knees, and flanks, with ill-defined yellowish macules on the upper and lower lips and buccal mucosae. Genital mucosa was normal. Cerebral
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Dr. Shoba Ramesh

Dr. Shoba Ramesh 0

Posted (edited)

histiocytes, giant cells and edema and extravasation of RBC, papulonecrotic TB. 

Edited by Dr. Shoba Ramesh
better understanding of cell infiltates and CPC

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Richard Logan

Richard Logan 0

Posted

We have to tie up the clinical description of necrotic macules and papules with the granulomatous histology including many giant cells.  I am inclined towards an infective aetiology, along the lines of papulo-necrotic tuberculid, or perhaps leprosy.  Certainly special stains are called for here.

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vincenzo

vincenzo 4

Posted

Difficult. ?Necrobiotic xanthogranuloma. 

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Richard Logan

Richard Logan 0

Posted

1 hour ago, vincenzo said:

Difficult. ?Necrobiotic xanthogranuloma. 

I think it would be most unusual for NXG to cause numerous brownish lesions scattered so widely.  NXG usually looks yellow, with at most a few lesions, mainly around the eyes.

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Sasi Attili

Sasi Attili 85

Posted

This was diagnosed as Non-Langerhan Cell Histiocytosis. CD68+ve. S100 and Cd1a -ve. 

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