A 62-year-old man presenting with widespread nodulo-ulcerative cutaneous lesions

A 62‐year‐old man was admitted to hospital with a widespread painful ulcerating eruption. His symptoms had started 3 months earlier when he developed an itchy erythematous rash over the abdomen. His general practitioner prescribed a course of oral prednisolone and amoxycillin, and rash and irritation settled. Two months later, the rash recurred, but this time it was more extensive and scaly. A diagnosis of psoriasis was made and he was commenced on tacalcitol topically for 5 months with no improvement. He subsequently deteriorated with widespread ulcerating plaques and nodules, and he was referred to the dermatology service. Prior to the onset of this condition, he was fit and healthy, with neither history of cutaneous disorders nor significant medical illnesses. He had received no medications and had no known allergies. He had been stationed in Africa with the army during his early twenties, and had travelled abroad over Europe infrequently since. He smoked 10 cigarettes daily and did not drink alcohol.