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An uncommon cause of haematochezia in an adult with skin rash
  1. A Hokama,
  2. K Shimoji,
  3. M Nakamura,
  4. H Chinen,
  5. K Kishimoto,
  6. T Hirata,
  7. F Kinjo,
  8. J Fujita
  1. First Department of Internal Medicine, University of the Ryukyus, Okinawa, Japan
  1. Dr A Hokama, First Department of Internal Medicine, University of the Ryukyus, 207 Uehara, Nishihara, Okinawa 903-0215, Japan; hokama-a{at}

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A 38-year-old man presented with sore throat and cough. Skin rash appeared 4 days later. Two weeks prior to presentation he had acute onset of lower abdominal pain and haematochezia. His medical history was unremarkable. Physical examination showed palpable purpura on the lower extremities and tenderness in the right lower quadrant but no fever. Pathology laboratory values included leukocytes 14.6×109/litre; and C-reactive protein 3.98 mg/dl (normal, <0.38 mg/dl). Urinalysis and stool culture were negative.


Skin rash (fig 1), a contrast-enhanced computed tomography (CT) scan (fig 2) and a single balloon enteroscopic picture of the ileum (fig 3) are shown. What is the diagnosis?

Figure 1 Picture of the right foot.
Figure 2 Contrast-enhanced computed tomography scan of the abdomen.
Figure 3 Single balloon enteroscopic picture of the ileum.

See page 1447 for the answer

This case is submitted by:


  • Competing interests: None declared.

  • Patient consent: Obtained.

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