Clinicopathologic conference: Inflammatory dermatopathology

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Clinicopathologic conferenceInflammatory
dermatopathology

• Philip E. LeBoit, M.D.
• Depts. of Pathology Dermatology
• University of California, San Francisco

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Case 1
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RECURRING URTICARIAL PLAQUES X 10 YRS AND RECENT
H/O TRANSVERSE MYELITIS (10/04), CURRENTLY ON
PREDNISONE CELLCEPT, PREV BX 12/04
(DS05-14488) CHRONIC URTICARIA VS URTICARIAL
VASCULITIS VS SWEET'S
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Second biopsy
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First biopsy
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Case 2
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• 57 YEAR OLD FEMALE WITH 6 WEEKS OF PAINFUL
  KERATOTIC LESIONS OF THE SOLES, ALSO SCALY
  ERUPTION IN GROIN, R/O PSORIASIS

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Physical Exam

• Marked hyperkeratosis of the soles with
  accentuation over weight bearing areas
• Focally the epidermis seems to be eroding
• Patient unable to walk due to pain

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History

• Massive Obesity
• Recent gastric stapling procedure
• Unable to eat without significant abdominal pain
• Gradual weight loss of 30 lbs over the last few
  months following the surgery

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Additional Findings

• PE Annular red plaques in the groin and
  inframammary area
• KOH for yeast
• Topical Nystatin ineffective

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Additional Findings

• Cheilitis
• Atrophic tongue

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Case 3
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Clinical history

• HISTORY OF T. CORPORIS, ON LAMISIL 250 QD X 6
  WEEKS, DEVELOPED
• ERYTHEMATOUS, IRREGULARLY SHAPED 6-8 MM MACULES

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Case 4
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Clinical data

• 33 year old Asian female with tender nodules on
  the legs for 3 months.

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Case 5
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Clinical data

• Widespread erythema, positive Nikolsky sign, rule
  out TEN

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Additional biopsies were done.
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Case History

• 47 year-old Asian man presented to emergency
  department with complaint of sore throat 5 days
  prior to admission
• Started on penicillin V 500mg PO TID for presumed
  pharyngitis
• Penicillin was stopped 24 hours later due to
  morbilliform eruption
• Over next 4 days, rash rapidly progressed

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Laboratory Findings

• Temperature 38.7ºC
• WBC22.2
• (88 neutrophils)
• Renal functionWNL

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Case 6

• A 71 year old man had a lesion on the neck
  thought to be an abscess. There was a history of
  lymphoma, and one of a spongiotic dermatitis.

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Case 7

• A 22 month old girl had a linear band on the
  torso, with a hyperpigmented atrophic appearance

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