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A 3 3 -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. Fresh skin biopsies were performed, and the patient was referred to the Gastroenterology department for a colonoscopy.


Physical Examination:

Numerous erythematous papules and plaques, ranging in size from 4mm to 30 mm, some with central pustules, were located on the lower extremities, hips, buttocks, and left abdomen. A 1 cm ulcer with surrounding erythema and scattered papulopustules wre also noted on the right hip (Figures 1,2).

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