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A 33 -year old Caucasian female was seen at a Washington University Dermatology clinic for recurrent ulcers on her legs and abdomen for almost 10 years, during which time pyoderma gangrenosum and nodular vasculitis were considered within the differential diagnosis. She recently returned, noting a new crop of eruptions and the recent onset of severe diarrhea and abdominal discomfort. On further questioning, a history of anal fissures and a rectal abscess was elucidated. Skin biopsies were performed.


Physical Examination:

Numerous erythematous papules and plaques, ranging in size from 4min to 30 min, some with central pustules, were located on the lower extremities, hips, buttocks, and left abdomen. A 1.0 cm ulcer with surrounding erythema was also noted on the right hip (Figure 1). Several erythematous papules were also present at the superior aspect of the ulcer.s

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