Joined
·
234 Posts
17 Year is seen in an emergency department with severe acute abdominal symptoms that suggest appendicitis. The patient had a similar episode previously that led to an appendectomy, but the appendix was free of inflammation at pathologic examination. On questioning, the boy reports having had intermittent diarrhea with moderate chronic abdominal pain for several years, which he had been afraid to tell anyone about after having had a "normal" appendix removed. On physical examination, the boy is noted to be thin, with short stature, and have a palpable fullness in the right lower quadrant of his abdomen. Ultrasound examination of the abdomen shows some thickening of bowel mesentery, but no distinct masses. Colonoscopy demonstrates sharply demarcated segments of diseased bowel with patchy mucosal ulcers separated by adjacent normal bowel involving both the distal ileum and right side of the colon. Examination of the patient's legs reveals necrotic ulcers with ragged bluish-red overhanging edges together with areas containing plaques with pustules.
Which of the following is the most likely diagnosis?
A. Eruptive xanthomata
B. Lupus vulgaris
C. Raynaud's phenomenon
D. Psoriasis
E. Pyoderma gangrenosum
Which of the following is the most likely diagnosis?
A. Eruptive xanthomata
B. Lupus vulgaris
C. Raynaud's phenomenon
D. Psoriasis
E. Pyoderma gangrenosum
