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Acquired perforating dermatosis（孔祥田(Max)*Roswell*NM]分享及讲解）
31 yo F, right abdomen punch biopsy. Patient has history of diabetes, recurrent pustular eruptions on face, trunk, arms, and legs for many years, and also mucosal erosions. Periodic episodes with atrophic scarring at sites of prior lesions. Concerning for autoimmune disorder but immunoflurence study is negative. Gram positive cocci identified. Negative for fungal elements on both PAS and GMS stains. Dx?
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I did elastic to rule out elastosis perforans serpiginosa(EPS). Trichrome will be positive for sure since I see the collagen bands in the lesion by H&E.
Here is my report： Acquired perforating dermatosis. See Diagnosis Comment. Sections show skin ulcer with perforating collagen fibers and neutrophils with bacterial colonies. The differential diagnosis includes reactive perforating collagenosis, Kyrle disease, and elastosis perforans serpiginosa (EPS). Elastin stain is negative ruling out the possibility of EPS. The remaining differential diagnoses can be related to underlying diabetic mellitus, and hepatic or renal disorders. Trichrome stain highlights the collagen fibers in the ulcerative area. Gram stains show gram-positive cocci within the lesion which could be secondary change in the ulcerative area. No fungal elements are identified on both PAS and GMS stains. Clinical correlation is recommended.
Thank @Henry for helping out with this case.
abin老师翻译原文：
女，31岁，右侧腹部钻孔活检。有糖尿病史，面部、躯干和腿部复发性脓疱疹多年，并有粘膜溃疡。以前发病部位周期性发作并有萎缩性瘢痕。考虑自身免疫性疾病，但免疫荧光阴性。检出革兰阳性球菌。PAS和GMS染色未见真菌。诊断？
我做了弹力纤维染色，以排除匐行性穿通性弹力纤维病(EPS)。HE染色见到胶原束，因此三色染色肯定是阳性。
我的报告：获得性穿通性皮肤病。见诊断评注。
切片示皮肤溃疡伴穿孔性胶原纤维和中性粒细胞和菌丛。鉴别诊断包括反应性穿通性弹力纤维病、Kyrle病和匐行性穿通性弹力纤维病(EPS)。其他鉴别诊断可能与原先的糖尿病、肝或肾疾病有关。在溃疡部位，三色染色突出显示胶原纤维。革兰染色示革兰阳性球菌，可能是继发改变。PAS和GMS染色未见真菌。建议结合临床考虑。谢谢@Henry帮助此病例。
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