General Dermatology and Dermatology in Primary Healthcare

A gentleman 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 then his lower extremities. Pleomorphic, umbilicated and eroded papulonodules of varying stages of evolution were present with porcelain white atrophic centres. A CT scan of the abdomen indicated a bowel perforation. An exploratory laparotomy revealed serosal white plaques throughout the bowel. This gentleman subsequently experienced three further bowel perforations within one month, complicated by anastomotic dehiscence, fistulation and secondary peritonitis. Histological examination of the bowel and skin showed obliterative intimal arteriopathy, histiocytes, thrombi and perforation through the tissue specimen