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Endgames Case Review

Multiple eruptive ulcers in a patient with quiescent ulcerative colitis

BMJ 2019; 364 doi: https://doi.org/10.1136/bmj.l847 (Published 28 March 2019) Cite this as: BMJ 2019;364:l847
  1. Angela Tewari, ST6 dermatology SpR,
  2. Asif Mahmood, consultant gastroenterologist,
  3. Christopher Harland, consultant dermatologist
  1. St Helier Hospital, Carshalton, UK
  1. Correspondence to A Tewari angela.tewari{at}nhs.net

A 65 year old man with ulcerative colitis presented with a one week history of rapidly expanding, painful, necrotic ulcers over the lower limbs, perineum, and peristomal skin. He had no bowel symptoms. Eighteen months earlier he had undergone a subtotal colectomy and stoma formation. His ulcerative colitis was then in remission and he had been treatment free since then.

On examination he was pyrexial and drowsy with a Glasgow coma scale of 14/15. His stoma was functioning well. Multiple purple edged ulcers with central slough (fig 1) affected large areas of both legs as well as a 10×5 cm area in the right groin. There was also a peristomal ulcer surrounding the entire stoma site. Blood results are shown in table 1.

Fig 1

Widespread ulcerating ulcers with overhanging edges on the lower legs

View this table:
Table 1

Blood results

Surgical debridement was cancelled after review by a dermatologist. All wound swabs and blood cultures remained negative.

Questions

  • 1. What is the diagnosis?

  • 2. What is the link …

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