Pneumatosis Coli in a Dog

2008 ◽  
Vol 44 (1) ◽  
pp. 32-35 ◽  
Author(s):  
Nicholas J. Russell ◽  
Dayle Tyrrell ◽  
Peter J. Irwin ◽  
Catherine Beck
Keyword(s):  
Weight Loss ◽  
Differential Diagnosis ◽  
Clinical Signs ◽  
Colorectal Disease ◽  
Abdominal Radiography ◽  
Pneumatosis Coli ◽  
History Of ◽  
Oral Metronidazole

A 17-year-old, castrated male Maltese was presented with chronic polyphagia and a 2-week history of tenesmus, diarrhea, hematochezia, weight loss, and ribbon-like feces. Pneumatosis coli was diagnosed by abdominal radiography. Concurrent hyperadrenocorticism was suspected. The clinical signs of colorectal disease resolved within 2 days of initiating a lowresidue diet and oral metronidazole. Pneumatosis coli should be considered as a differential diagnosis for colorectal disease in dogs.

Pneumatosis Coli in a Dog

2019 ◽  
Vol 55 (4) ◽  
Author(s):  
Amanda Fisk ◽  
Ashley Allen-Durrance
Keyword(s):  
Hyperbaric Oxygen ◽  
Clinical Signs ◽  
Digital Rectal Examination ◽  
Colorectal Disease ◽  
Pneumatosis Coli ◽  
Colonic Wall ◽  
Free Air ◽  
Immune Mediated ◽  
Abdominal Radiographs ◽  
History Of

ABSTRACT The objective of this report is to document a case of pneumatosis coli in an immunosuppressed dog successfully treated with supportive care that included hyperbaric oxygen. A 9 yr old, neutered male Maltese was presented for hematochezia of ∼36 h duration. The dog had a history of immune-mediated thrombocytopenia that was well managed with prednisone and azathioprine. Initial evaluation was unremarkable except for increased rectal temperature and hematochezia on digital rectal examination. Abdominal radiographs revealed diffuse gas within the colonic wall consistent with pneumatosis coli. Scant-free air was also appreciated in the peritoneal and retroperitoneal cavities. The dog was managed for 4 days in hospital with broad spectrum antibiotic, anthelminthic, and gastroprotectant therapy. He received one session of hyperbaric oxygen therapy while in hospital. Repeat abdominal radiographs after 72 hr of medical management showed improvement of the pneumatosis coli. After 4 days of hospitalization, he was discharged with resolution of clinical signs. Pneumatosis coli is rarely diagnosed in dogs but should be considered in cases with clinical signs of colorectal disease.

scholarly journals Equine enterolithiasis

2017 ◽  
Vol 59 (2) ◽  
pp. 105
Author(s):  
N. DIAKAKIS (Ν.ΔΙΑΚΑΚΗΣ)
Keyword(s):  
Clinical Signs ◽  
Intestinal Bacteria ◽  
Accurate Method ◽  
Poor Quality ◽  
Surgical Removal ◽  
Daily Consumption ◽  
Abdominal Radiography ◽  
South West ◽  
History Of ◽  
Main Components

Enterolithiasis is characterized by the presence of enteroliths in the large colon of horses with the ascending colon being the most common site of obstruction. Enteroliths are composed of ammonium magnesium phosphate, which is supplied both by the digestive processes intestinal bacteria and by feeds. The enteroliths typically form around a central nidus. Although enterolithiasis is seen all over the world, the most cases are reported from North America, and more specifically, California, South West Indiana and Florida. As far as breed is concerned, it affects predominantly Arab horses and rarely Quarter and Thoroughbreds. As far as age is concerned, it is usually seen in middle-aged horses. Although the pathogenesis of enterolithiasis is not fully understood, nutrition and heritability are believed to be a part in it. A rich diet in ammonium, magnesium and phosphorus predisposes to enterolith formation, as those elements are the main components of enteroliths. Clinical signs vary considerably and are rarely characteristic of the disease. Usually, the presence of the enterolith is free of symptoms unless it leads to obstruction. In most cases of enterolithiasis a small amount of faeces, air and the administered mineral oil could pass from the obstruction site. On the contrary, in complete obstructions the passage is closed, defecation is absent and no laxative can pass the obstruction site. The enterolith is rarely found by rectal examination. A history of recurrent colic might be connected to the presence of enteroliths that cause partial or temporary obstruction. The most accurate method for diagnosing enterolithiasis is abdominal radiography. The treatment of choice is the surgical removal of enteroliths, which has a favorable prognosis provided that the laparotomy is going to take place early in course of the disease, before the onset of peritonitis. Intestinal rupture, which rapidly leads to peritonitis, is the gravest and commonest complication. Other complications are colitis, leakage through the laparotomy site and peritonitis. In order to prevent reformation of enteroliths, the daily consumption of alfalfa hay has to be reduced dramatically and poor quality hay has to be administered.

scholarly journals Incidence, Clinical Profile, and Risk Factors for Serious Bacterial Infections in Children Hospitalized With Fever in Ujjain, India

2020 ◽  
Author(s):  
Ashish Pathak ◽  
Radika Upadhayay ◽  
Aditya Mathur ◽  
Sunil Rathi ◽  
Cecilia Stålsby Lundborg
Keyword(s):  
Risk Factors ◽  
Weight Loss ◽  
Urinary Tract Infection ◽  
Urinary Tract ◽  
Tract Infection ◽  
Blood Culture ◽  
Positive Blood Culture ◽  
Clinical Signs ◽  
Increased Risk ◽  
History Of

Abstract Background Fever is a cause for concern for both parents and the treating pediatrician and a common reason for antibiotic overuse. However, the proportion of children hospitalized for fever with serious bacterial infection (SBI) is uncertain. We aimed to evaluate the epidemiological, clinical, hematological, and biochemical risks for SBI among the children admitted with fever. Method This prospective study was conducted in a rural teaching hospital in India on consecutive children, aged 3 months–12 years, presenting with fever 100°F (37.7°C) or higher. The presence of SBI was confirmed with one of the following criteria: (a) a positive blood culture; (b) roentgenographically confirmed pneumonia with high titres of C-reactive protein; (c) a culture-confirmed urinary tract infection; (d) enteric fever diagnosed clinically in addition to either a positive blood culture or high Widal titers; and (e) meningitis diagnosed clinically in addition to either a positive blood culture or cerebrospinal fluid culture. A predefined questionnaire was filled. Results A total of 302 children were included in the study, out of which 47% (95% CI 41.4%-52.7%) presented with SBI. The factors associated with confirmed SBI in bivariate analysis were history of previous hospitalization, history of chronic illness, history of medication in the previous one week, a partially immunized child, history of common cold, moderate-grade fever, toxic look, significant lymphadenopathy, absence of BCG scar, delayed development, irritability, breathlessness, respiratory distress, poor feeding, significant weight loss, suspected urinary tract infection, hyponatremia, hypokalemia, and abnormal leucocyte count. The final generalized logistic regression model revealed partially immunized child (RR 4.26), breathlessness (RR 1.80), weight loss (RR 2.28), and suspected urinary tract infection (RR 1.95) as risk factors for the increased risk of SBI. Conclusion The study identified multiple risk factors for SBI. Pediatricians can be made aware of these risk factors. Further studies are warranted to identify age-specific risk factors for SBI because most clinicians depend on clinical signs and symptoms to identify SBI.

scholarly journals 14. A severe case of connective tissue disease related interstitial lung disease in a young woman

2019 ◽  
Vol 3 (Supplement_1) ◽  
Author(s):  
Kate Grant ◽  
Patrick McShane ◽  
Kathryn Kerr ◽  
Martin Kelly ◽  
Philip Gardiner ◽  
...  
Keyword(s):  
Weight Loss ◽  
Systemic Sclerosis ◽  
Connective Tissue ◽  
Connective Tissue Disease ◽  
Lung Biopsy ◽  
Clinical Signs ◽  
Clinical Manifestations ◽  
Connective Tissue Disorder ◽  
Young Age ◽  
History Of

Abstract Introduction Interstitial lung disease (ILD) can occur in any connective tissue disease, with varying degrees of respiratory clinical manifestations. In the majority of cases, patients have an established connective tissue diagnosis that precedes the development of ILD by many years. This discussion will focus on the unusual presentation of an 18 year old female admitted with a short history of weight loss and breathlessness. Investigations showed extensive established ILD with strongly positive autoantibodies, but in the absence of clinical signs of an underlying connective tissue disorder apart from Raynaud’s phenomenon. Case description 18-year-old female presented with a three-month history of unintentional 25kg weight loss, six weeks of fatigue/malaise, and a two-week history of worsening breathlessness. She was a student, non-smoker, with no past medical history except for class I obesity, and not on regular medications. On examination she had fine bibasal end-inspiratory crackles, SaO2 96% RA and Raynaud’s phenomenon was observed. Her CXR demonstrated bibasal consolidation. CT imaging identified bilateral symmetrical peripheral patchy ground glass opacities and patchy consolidation with basal predominance. Bloods revealed rheumatoid factor 491.2, anti-RNP A ab 7.91, anti-Sm ab > 8 and anti-chromatin ab 7.3, speckled ANA positive titre of 40, Complement C4 0.08, ESR 29 and HIV negative. Pulmonary function tests demonstrated a restrictive pattern FEV1 2.08L (72%), FVC 2.43L (73%), Ratio 85% and reduced transfer factor - DLCO 41%, KCO 61%. Ambulatory oxygen assessment showed desaturation to 77% RA. Bronchoscopy revealed inflamed airways and a bronchoalveolar lavage (BAL) cell count of 0.6 x 106 - 42% macrophages, 32% neutrophils, 24% eosinophils, 2% lymphocytes. At the local ILD MDT a differential diagnosis of LIP or NSIP was considered. Following discussion with rheumatology she was referred to the thoracic surgical team for lung biopsy. She proceeded to surgical biopsy of her right lung without complication. Unfortunately, she continued to experience worsening breathlessness and myalgia and she was commenced on prednisolone (40mg), with some radiological improvement but no symptomatic benefit. The pathology from her lung biopsy demonstrated significant fibrosis with scattered lymphoid aggregates, microscopic honeycombing with multiple fibroblastic foci and diffuse changes, in keeping with a fibrotic NSIP pattern. Her case was discussed at Freeman Hospital Newcastle ILD MDT who advised that her presentation was in keeping with a mixed connective tissue/lupus-related NSIP, and suggested commencing methylprednisolone, cyclophosphamide and rituximab. Discussion On initial assessment, the patient’s age and symptoms of rapid weight loss and profound exertional dyspnoea were concerning. Her resting oxygen saturations were satisfactory, but she became markedly hypoxic on ambulating short distances, indicating serious respiratory pathology. The initial CXR showed ‘faint patchy consolidation’, but CT scan showed extensive interstitial changes, accounting for her dyspnoea and desaturation on exertion. Further investigations including rheumatoid factor, anti-RNP and anti-Sm antibody were found to be strongly positive, suggesting an underlying mixed connective tissue disorder. However, the patient did not complain of any symptoms related to arthritis, SLE, systemic sclerosis or polymyositis and no positive clinical findings were noted on examination in support of these diagnoses. The BAL analysis was consistent with CT-ILD but not specific enough for diagnosis. A lung biopsy was performed on advice of the ILD lung MDT as the abnormalities on CT imaging could be in keeping with several pathologies with very different associated prognosis and management. The biopsy appearance correlated poorly with the cell count in BAL fluid. Discussion at local and regional ILD MDTs was particularly helpful given the severity of ILD and her young age. The ILD MDT provided a consensus of expert advice on optimal management and confirmed our concern about the extent of established fibrosis and the need for aggressive management. This obviously has significant implications for the patient in many ways, but particularly regarding fertility given her young age and she was therefore referred to the regional fertility clinic for counselling. Key learning points This was a particularly unusual case because the patient presented acutely at a very young age with established fibrotic damage on lung biopsy. It is also noteworthy that she presented so acutely with advanced ILD even though there were no positive clinical signs on examination, and no symptoms or signs of an underlying connective tissue disease. Lung biopsy is not routinely indicated in patients with progressive (respiratory) clinical manifestations of CT ILD, particularly in patients with an established diagnosis of rheumatoid arthritis or systemic sclerosis, as corticosteroids and/or immunosuppression are the mainstay of treatment regardless of the underlying CT pathology. However, lung biopsy is indicated where there is diagnostic uncertainty due to atypical presentations. In this case the biopsy findings were unexpected and resulted in a change to the initial management plan. Considerations about fertility and long term toxicity further complicated our choice of optimal therapy. This was a challenging case and highlighted the importance of multidisciplinary management of complex ILD cases. Discussions between local rheumatology, radiology and respiratory clinicians led to the decision that a biopsy was necessary. Subsequently the ILD MDT in the Freeman hospital provided clear expert guidance on in favour of a more aggressive treatment regimen than may have been otherwise initially considered. Conflict of interest The authors declare no conflicts of interest.

scholarly journals Urachal Adenocarcinoma: A Case Report with Key Imaging Findings and Radiologic-Pathologic Correlation

2018 ◽  
Vol 2018 ◽  
pp. 1-5 ◽  
Author(s):  
Willian Schmitt ◽  
Marta Baptista ◽  
Marco Ferreira ◽  
António Gomes ◽  
Ana Germano
Keyword(s):  
Weight Loss ◽  
Differential Diagnosis ◽  
Clinical History ◽  
Imaging Findings ◽  
Lesion Location ◽  
Patient Demographics ◽  
Pathologic Correlation ◽  
Associated Symptoms ◽  
History Of ◽  
Urachal Adenocarcinoma

Urachal pathologies are rare and can mimic numerous abdominal and pelvic diseases. Differential diagnosis of urachal anomalies can be narrowed down by proper assessment of lesion location, morphology, imaging findings, patient demographics, and clinical history. We report a case of a 60-year-old male, with a history of unintentional weight loss without associated symptoms, who was diagnosed with locally invasive urachal adenocarcinoma. With this article, we pretend to emphasize urachal adenocarcinoma clinical features along with its key imaging findings with radiologic-pathologic correlation.

scholarly journals Case-Control Study of Risk Factors Associated with Feline and Canine Chronic Kidney Disease

2010 ◽  
Vol 2010 ◽  
pp. 1-9 ◽  
Author(s):  
Paul C. Bartlett ◽  
James W. Van Buren ◽  
Andrew D. Bartlett ◽  
Chun Zhou
Keyword(s):  
Risk Factors ◽  
Weight Loss ◽  
Case Control Study ◽  
Clinical Signs ◽  
Case Control ◽  
Factors Associated ◽  
History Of ◽  
Bad Breath ◽  
Dog Owners ◽  
Control Study

An age-matched case-control study was initiated to determine the major risk factors associated with CKD in cats and dogs and to determine what clinical signs cat and dog owners observed before their veterinarian diagnosed their pet with CKD. When compared to controls, the feline cases were more likely to have had polydipsia and polyuria in the year before the owners' cats were diagnosed with CKD. In the dogs, increased water intake, increased urination, small size and a recent history of weight loss and bad breath were noticed by the dog owners before veterinary CKD diagnosis. Dog owners recognized abnormal drinking and urination behavior over half a year before their pet's veterinary diagnosis with CKD, and they recognized weight loss almost 4 months before CKD diagnosis. Bad breath was noticed 1.2 years before recognition of CKD by a veterinarian. Given that earlier CKD diagnosis should have been possible in most cases, clinical trials should proceed to measure the efficacy of early interventions.

scholarly journals Carcinoma with Vertebral Column Metastasis in Two Dogs

2020 ◽  
Vol 48 ◽  
Author(s):  
Thierry Grima De Cristo ◽  
Laura Formighieri De Noronha ◽  
Giovana Biezus ◽  
Cinthya Dos Santos Cerqueira ◽  
Natália Coelho Couto de Azevedo Fernandes ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Weight Loss ◽  
High Power ◽  
Mammary Carcinoma ◽  
Clinical Condition ◽  
Vertebral Column ◽  
Clinical Signs ◽  
History Of ◽  
Progressive Weight Loss ◽  
Pelvic Limb

Background: Carcinomas are aggressive and invasive malignancies that originate from any type of epithelial cell and are responsible for many deaths in dogs. Carcinoma metastases occur primarily via the lymphatic route; however, they can occur by blood flow, thus reaching bone structures. In dogs, metastasis of mammary and squamous cell carcinomas to the skeletal system is poorly described. The aim of this study was to report two cases of dogs that developed metastases of carcinomas to the vertebral column.Cases: Case 1. A 10 years-old, male, mixed-breed dog with paralysis of the left pelvic limb, subcutaneous mass in the lumbar region, apathy, anorexia and progressive weight loss and with a previous history of amputation of the right pelvic limb resulting from squamous cell carcinoma (SCC) in the integument of the cranial face of the femorotibiopatellar joint. Due to the patient's clinical condition and the negative prognosis associated with the neoplasia, euthanasia was performed. At necropsy, infiltrating the lumbar vertebrae from L5 to L7, a whitish and firm mass of approximately 15 x 8 cm was observed. Histologically, it comprised a malignant epithelial neoplastic development consisting of nests and cords interspersed with fibrovascular stroma, containing multiple keratine pearls. There was moderate to severe anisocytosis, severe anisokariosis, and about 4 mitosis figures for every 10 high power fields (400x). The histological features were consistent with an invasive SCC. Anti-cytokeratin and anti-p63 immunohistochemical (IHC) evaluations were performed, both with immunoreactivity in neoplastic cells. Case 2. An 8 years-old, female, Chihuahua with bilateral paralysis of the pelvic limbs, anorexia, and progressive weight loss, with a history of excision of solid mammary carcinoma. The clinical condition evolved to the absence of deep pain in all limbs and fecal and urinary retention, opting for euthanasia. At necropsy, a nodule between T3 and T4 was observed, yellowish-white and firm, measuring about 5 x 3.8 cm, invading the spinal canal, and compressing the spinal cord. Histologically, it comprised malignant epithelial neoplasia infiltrating intervertebral ligaments, musculature, and vertebrae of the thoracic spine, organized in a dense mantle of polygonal to rounded cells, delimited in lobes by abundant fibrovascular tissue. Moderate anisokaryosis and accentuated anisocytosis were observed and about 6 mitosis figures for every 10 high power fields (400x). The histological characteristics of the tumor were compatible with metastasis due to grade II solid mammary carcinoma. Immunohistochemical evaluations of anti-cytokeratin, anti-c-erbB2, and anti-estrogen and progesterone receptors were performed, with immunoreactivity for cytokeratin and c-erbB2 in neoplastic cells.Discussion: There are no current data indicating which tumors that metastasize most frequently to the vertebral column. In the reported cases, it was found that the clinical signs presented by the animals are directly associated with the compression of specific areas of the spinal cord, as well as bone pain, resulting from tumor expansion and degeneration of the bone matrix, similar to what has been reported previously. The immunohistochemical diagnosis of anti-p63 in case 1 and anti-oncoprotein C-erbB2 in case 2, were essential to determine the neoplastic origin in the absence of the primary tumor. Despite being a place of low incidence of metastases, bones have a physiologically favorable environment for the implantation of neoplastic cells, especially when there is bone marrow involvement. Because of this and despite the rare occurrence, metastasis of carcinomas to the vertebral column should always be considered as differential diagnoses in patients presenting with clinical signs compatible with spinal cord compression and a history of previous neoplasia.

scholarly journals Incidence, Clinical Profile, and Risk Factors for Serious Bacterial Infections in Children Hospitalized With Fever in Ujjain, India

2019 ◽  
Author(s):  
Ashish Pathak ◽  
Radika Upadhayay ◽  
Aditya Mathur ◽  
Sunil Rathi ◽  
Cecilia Stålsby Lundborg
Keyword(s):  
Risk Factors ◽  
Weight Loss ◽  
Urinary Tract Infection ◽  
Urinary Tract ◽  
Tract Infection ◽  
Blood Culture ◽  
Positive Blood Culture ◽  
Clinical Signs ◽  
Increased Risk ◽  
History Of

Abstract Background Fever is a cause for concern for both parents and the treating pediatrician and a common reason for antibiotic overuse. However, the proportion of children hospitalized for fever with serious bacterial infection (SBI) is uncertain. We aimed to evaluate the epidemiological, clinical, hematological, and biochemical risks for SBI among the children admitted for fever. Method This prospective study was conducted in a rural teaching hospital in India on consecutive children, aged 3 months–12 years, presenting with fever 100°F (37.7°C)or higher. The presence of SBI was confirmed with one of the following criteria: (a) a positive blood culture; (b) roentgenographically confirmed pneumonia with high titres of C-reactive protein; (c) a culture-confirmed urinary tract infection; (d) enteric fever diagnosed clinically in addition to either a positive blood culture or high Widal titers; and (e) meningitis diagnosed clinically in addition to either a positive blood culture or cerebrospinal fluid culture. A predefined questionnaire was filled. Results The study included 302 patients of whom 47% presented with SBI. The factors associated with confirmed SBI in bivariate analysis were history of previous hospitalization, history of chronic illness, history of medication in the previous 1 week, a partially immunized child, history of common cold, moderate-grade fever, toxic look, significant lymphadenopathy, absence of BCG scar, delayed development, irritability, breathlessness, respiratory distress, poor feeding, significant weight loss, suspected urinary tract infection, hyponatremia, hypokalemia, and abnormal leucocyte count. The final generalized logistic regression model revealed partially immunized child (RR 4.26), breathlessness (RR 1.80), weight loss (RR 2.28), and suspected urinary tract infection (RR 1.95) as risk factors for the increased risk of SBI. Conclusion The study identified multiple risk factors for SBI. Pediatricians can be made aware of these risk factors. Further studies are warranted to identify age-specific risk factors for SBI because most clinicians depend on clinical signs and symptoms to identify SBI.

scholarly journals Incidence, Clinical Profile, and Risk Factors for Serious Bacterial Infections in Children Hospitalized With Fever in Ujjain, India

2020 ◽  
Author(s):  
Ashish Pathak ◽  
Radika Upadhayay ◽  
Aditya Mathur ◽  
Sunil Rathi ◽  
Cecilia Stålsby Lundborg
Keyword(s):  
Risk Factors ◽  
Weight Loss ◽  
Urinary Tract Infection ◽  
Urinary Tract ◽  
Tract Infection ◽  
Blood Culture ◽  
Positive Blood Culture ◽  
Clinical Signs ◽  
Increased Risk ◽  
History Of

Abstract Background Fever is a cause for concern for both parents and the treating pediatrician and a common reason for antibiotic overuse. However, the proportion of children hospitalized for fever with serious bacterial infection (SBI) is uncertain. We aimed to evaluate the epidemiological, clinical, hematological, and biochemical risks for SBI among the children admitted with fever. Method This prospective study was conducted in a rural teaching hospital in India on consecutive children, aged 3 months–12 years, presenting with fever 100°F (37.7°C) or higher. The presence of SBI was confirmed with one of the following criteria: (a) a positive blood culture; (b) roentgenographically confirmed pneumonia with high titres of C-reactive protein; (c) a culture-confirmed urinary tract infection; (d) enteric fever diagnosed clinically in addition to either a positive blood culture or high Widal titers; and (e) meningitis diagnosed clinically in addition to either a positive blood culture or cerebrospinal fluid culture. A predefined questionnaire was filled. Results A total of 302 children were included in the study, out of which 47% (95% CI 41.4%-52.7%) presented with SBI. The factors associated with confirmed SBI in bivariate analysis were history of previous hospitalization, history of chronic illness, history of medication in the previous one week, a partially immunized child, history of common cold, moderate-grade fever, toxic look, significant lymphadenopathy, absence of BCG scar, delayed development, irritability, breathlessness, respiratory distress, poor feeding, significant weight loss, suspected urinary tract infection, hyponatremia, hypokalemia, and abnormal leucocyte count. The final generalized logistic regression model revealed partially immunized child (RR 4.26), breathlessness (RR 1.80), weight loss (RR 2.28), and suspected urinary tract infection (RR 1.95) as risk factors for the increased risk of SBI. Conclusion The study identified multiple risk factors for SBI. Pediatricians can be made aware of these risk factors. Further studies are warranted to identify age-specific risk factors for SBI because most clinicians depend on clinical signs and symptoms to identify SBI.

Cutaneous Rosai–Dorfman disease: a challenging diagnosis

2021 ◽  
Vol 14 (2) ◽  
pp. e239244
Author(s):  
Rita Sampaio ◽  
Leandro Silva ◽  
Goreti Catorze ◽  
Isabel Viana
Keyword(s):  
Weight Loss ◽  
Differential Diagnosis ◽  
Physical Examination ◽  
Plasma Cells ◽  
Oral Prednisolone ◽  
Inflammatory Cells ◽  
Rosai Dorfman Disease ◽  
History Of ◽  
Nodular Lesions ◽  
Proliferative Disease

Rosai–Dorfman disease is a rare benign histiocytic proliferative disease of unknown cause that, in exceptional cases, presents with lesions confined to the skin. Clinically variable types of lesions such as papules, nodules and plaques have been reported. We present a case of a 27-year-old woman with a 1-year history of erythematous papular and nodular lesions on the malar and right axillary regions, previously misdiagnosed as acne. She reported no fever, malaise or weight loss, while physical examination and laboratory workup were normal. Bacteriological and mycobacteriological cultures were negative. Histopathological findings showed dense infiltration of inflammatory cells involving the entire dermis, consisting of large macrophages with emperipolesis, S100 and CD68 positive, neutrophils, eosinophils, lymphocytes and plasma cells. The patient was treated with oral prednisolone without improvement. Dapsone was subsequently initiated with favourable clinical response. The present article aimed to emphasise the clinical and histological differential diagnosis and share the treatment experience.

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