Qap (Anatomical Pathology) 

QAP Peer Review

AP113
Case History: M/63, diabetic, generalized skin rash.
Intended diagnosis: Fungal infection. Contributed by:PKH
Code Diagnosis Comment Score
anonymous Fungal infection and acantholytic dyskeratosis 100% Advise PAS stain to demonstrates the morphology of the fungus in stratum corneum. Differential diagnosis includes dermatophytosis and Candidiasis. The acute onset of skin lesions in elderly displaying acantholytic dyskeratosis suggests Grover's disease (transient acantholytic dermatosis).  100
anonymous Fungal infection, 100% To be confirmed with Grocott stain.  100
anonymous Superficial dermatophytosis, 100% Special stains for fungus to confirm the diagnosis, and Clinical as well as immunofluorescence studies to rule out a blistering process.  100
anonymous SKIN : Superficial fungal infection (100%) Special stains including periodic acid-Schiff stain with or without diastase pre-treatment and Grocott stain are necessary for confirmation. Fungal culture may be needed if necessary. A small depression with basophilic granular material and neutrophils is noted at the skin surface. Deeper sectioning is advised to exclude other diabetic associated diseases like Kyrle's disease.  100
anonymous acute generalised exanthematous pustulosis (50%) pustular psoriasiform dermatitis (50%) A drug and clinical history should be elicited.  50
anonymous Superficial fungal infection, 100% Demonstration of fungal organisms by PAS or Grocott stain.  100
anonymous Superficial perivascular dermatitis with parakeratosis. To exclude fungal infection by PASD & Grocott stains. 100%. nil  100
anonymous Fungal hyphae noted at cornified layers suggestive of dermatophytosis. (100%) Confirm by fungal stains (PAS, Grocott).  100
anonymous Suggestive of superficial fungal infection 100% ( e.g. Dermatophytosis, Candidiasis and Tinea versicolor ) Special stains ( PAS, Grocott ) to identify any fungal elements in the epidermis  100
anonymous Subcorneal pustular dermatosis (100%) Culture to exclude fungal infection.  95
anonymous Subcorneal pustular dermatitis, consistent with fungal infection( i.e. Candida) 100% * Fungal stains to confirm presence of fungal hyphae. * Further sampling/ deeper sections to exclude reactive perforating collagenosis.  100
anonymous Subcorneal pustule, suggestive of dermatophytosis or candiasis. PAS stain is recommended. 100% Suggestive of scleredema. 80% nil  95
anonymous Intraepidermal bulla with Acantholysis, favour pemphigus vulgaris 100% 1. Direct immunofluorescence examination of specimens from perilesional skin for IgG staining in the epidermal intercellular space (around individual keratinocyte) 2. Bullous eruption associated with DM typically does not show acantholysis. 3. No dyskeratosis nor lichenoid changes (may suggest association with internal malignancy or other acantholytic dermatosis) 4. Exclude pemphigus-like lesion induced by drug.  50
anonymous Acute dermatitis, most likely infective (see comment) There is a focus of suppuration. No bacteria or fungi are seen.  70
anonymous Dermatophytosis (tinea infection) Probability : 100% nil  100
anonymous Dermatophyte infection (100%) Various entities under acantholytic dyskeratosis have to be excluded by performing immunofluorescence and ultrastructural studies as well as clinical correlation.  100
anonymous Skin - Fungal infection (100%) nil  100