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Rheumatology consultation made a diagnosis of reactivearthritis in the right knee but without radiological changes.In making a certain diagnosis of AF, histopathologicalinvestigation is welcome. In current practice, the onlyinvestigation used is histopathology, while immunohistochemistryand electron microscopy are used rarely, mostlyfor research purposes.Skin biopsies were prepared according to the routinehistological technique at the Department of Histology,“Grigore T. Popa” University of Medicine and Pharmacyand Laboratory of Pathology, “Sf. Spiridon” EmergencyHospital, Iassy, Romania.The obtained fragments were fixed in 15% formalin,embedded in paraffin, and the 7–10 μm thick sectionswere stained with Hematoxylin–Eosin (HE), trichromeSzekely, Periodic Acid–Schiff (PAS) and Orcein.Histopathological appearance of AF was impressive.It revealed an ulceration, which included epidermis anddermis, with necrotic-leukocytary detritus in the base,papillomatous thickening of the epidermis in the slope,with discrete hyperkeratosis. Perivascularly, in the papillaryand middle dermis it was noticed the presence of a fibrinonecroticexudate and a polymorphous inflammatory infiltratewith integer and lysed PMNs (polymorphonuclears).In AF, comedones were present in small numbers andwith an intense inflammatory reaction in the surroundingskin (Figure 3). Pilosebaceous follicles in the affected areas were surrounded by an intense foreign body granulomatousreaction. The inflammatory reaction extended tothe middle and deep dermis and was polymorphic, consistingof PMNs, macrophages, lymphocytes and plasmacells.
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