Gastroenterology
Case 8: A Man with Vomiting and Crohn's Disease
CASE
A 24‐year‐old man presents in the clinic with progressive difficulty with vomiting. Four years previously he had had an ileal resection for Crohn's disease. He has a poor appetite but experiences abdominal pain 15–20 minutes after eating followed by bloating and vomiting. He has lost over a stone in weight and reports mouth ulcers, gritty eyes and low back pain. On examination he looks dry and unwell. His pulse is 110 beats/min and his temperature is 37.5°C. Abdominal examination reveals a diffuse mass in the right iliac fossa. In addition he has tender, raised, red blotches on his shins.
Blood tests showed:
Hb 9.2 g/dL WCC 12.2 × 109/L Platelets 650 × 109/L Plasma viscosity 2.3 cP Na 135 mmol/L K 2.7 mmol/L Urea 4.2 mmol/L Creatinine 78 µmol/L
QUESTION 1
Your score this session: 0 of 0
The lesions on the shins are most likely to be: