General dermatology and dermatology in primary healthcare

A man in his twenties, of Gambian descent, was admitted with abdominal pain and a long history of pruritic nodules progressing from his arms, back, neck and ultimately his lower extremities. Pleomorphic, umbilicated and eroded papulonodules of varying stages of evolution were present, with porcelain-white atrophic centres. Computed tomography of his abdomen indicated a bowel perforation. An exploratory laparotomy revealed white serosal plaques throughout the bowel. He subsequently experienced three further bowel perforations within 1 month, complicated by anastomotic dehiscence, fistulation and secondary peritonitis. Histological examination of the bowel and skin showed obliterative intimal arteriopathy, histiocytes, thrombi and perforation throughout the tissue specimen.