Case Number : Case 1753 - 15 February - Dr Hafeez Diwan Posted By: Guest

Dr Hafeez Diwan has a nice case here, don't rash into your diagnosis  :-)

Geoff Cross - DermpathPRO Projects

Geoff - Don't give up the day job. I seem to be losing a lot of REM sleep myself though.

Nice comment Dr Carr :-))

Thought of REM before reading Dr Carr's comment :-))

Agree, REM 

Agree with REM, :)

REM fits clinically well.

 I must honestly confess I was thinking about a LET ( perivascular and periadnexal infiltrate is dense, and mucin deposits are  deeply located in dermis). 

But REM is probably more correct!

Superficial and deep perivascular and periappendageal lymphocytic infiltrate associated with abundant mucin deposits widening the interstitial space between collagen bundles. Epidermal basal cell damage is lacking. This combination of microscopic characteristics make me think of lupus erythematosus tumidus. Reticular erythematous mucinosis is an excellent thought, too. Once both overlap clinical and histopathological features (actually, they are indistinguishable in the majority of cases), I believe they are manifestations of the same disease.

My thought was REM too, agree with Robledo regarding overlap of entities. 

I went with tumid lupus.

Agree with comments about the density of the infiltrate being a feature in favour of lupus.