Multiple eruptive ulcers in a patient with quiescent ulcerative colitisBMJ 2019; 364 doi: https://doi.org/10.1136/bmj.l847 (Published 28 March 2019) Cite this as: BMJ 2019;364:l847
- Angela Tewari, ST6 dermatology SpR,
- Asif Mahmood, consultant gastroenterologist,
- Christopher Harland, consultant dermatologist
- St Helier Hospital, Carshalton, UK
- Correspondence to A Tewari
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.
Surgical debridement was cancelled after review by a dermatologist. All wound swabs and blood cultures remained negative.
1. What is the diagnosis?
2. What is the link …