#DiagnosticDilemma: What is your take on this case??
A Man With Infiltrated Plaques on the Pretibial Area*

CLINICAL FINDINGS
A man in his late 20s presented with mildly itchy, erythematous plaques of 3 months’ duration on both legs. The lesions started to appear on the left pretibial region as small papules, which gradually increased in size and coalesced to form bigger plaques. No history of local trauma, prolonged standing, and occupational exposure to mineral dust or recent drug intake was recollected. He was not diabetic.

On examination, large, ill-defined, erythematous plaques were present on the pretibial areas extending onto the lateral aspect of both legs. The plaques were surmounted by multiple, discrete atrophic scars. The periphery of the plaques showed increased vascularity in the form of telangiectasias and venous prominences, along with atrophy of the overlying skin (Figure, 1). There were no lesions elsewhere on the body.

INVESTIGATIONAL FINDINGS
A skin biopsy sample was obtained from the plaque and sent for histopathological examination (Figure, 2 and 3). Skin biopsy revealed multiple, well-formed, compact, noncaseating epithelioid cell granulomas with many multinucleated Langhans type giant cells (Figure, 2 and 3).

Special stains for microorganisms including Ziehl-Neelsen and periodic acid–Schiff for acid-fast bacilli and fungus, respectively, had negative results. Intradermal testing with purified protein derivative and mycobacterial culture of the skin biopsy specimen had negative results.

What is your Diagnosis??
A. Granulomatous mycosis fungoides

B. Pretibial myxedema

C. Cutaneous sarcoidosis

D. Necrobiosis lipoidica


Answer to be disclosed shortly!

*The present case appears in JAMA
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Dr. N●●●●●●a V●●●a
Dr. N●●●●●●a V●●●a Internal Medicine
Granulomatous mycosis fungoidosis
Aug 29, 2018Like
Dr. R●●z  a●●●d
Dr. R●●z a●●●d Paediatric Neurology
Necrobiosis Lipoidica
Sep 10, 2018Like
Dr. R●●z  a●●●d
Dr. R●●z a●●●d Paediatric Neurology
Seen in elderly patients even without diabetes when their ambulation is restricted. Background cardiac medications including anticoagulants could trigger to some extent
Sep 10, 2018Like