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A Dutch patient presenting with a rare clinical syndrome
  1. Gijs Elshout1,
  2. Frank J M F Dor1,
  3. Leon C Verhoog2,
  4. Luuk Berk3,
  5. Wietske W Vrijland1
  1. 1Department of Surgery, Sint Franciscus Gasthuis, Rotterdam, The Netherlands
  2. 2Department of Pathology, Sint Franciscus Gasthuis, Rotterdam, The Netherlands
  3. 3Department of Internal Medicine, Sint Franciscus Gasthuis, Rotterdam, The Netherlands
  1. Correspondence to Dr Gijs Elshout, Department of Surgery, Sint Franciscus Gasthuis, Kleiweg 500, Rotterdam 3045 PM, The Netherlands; g.elshout{at}

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Clinical presentation

A 67-year-old Caucasian male presented with persistent diarrhoea, weight loss of 15 kg in 3 months, and onychodystrophy. Family history is negative for colon carcinoma. He worked in oil trading and had extensive exposure to sulfuric acid, ammonia and gum resin. Physical examination revealed a vaguely palpable mass and tenderness in the left lower abdominal quadrant. Onycholysis of the fingernails (figure 1) and toenails, alopecia (figure 2) and hyperpigmentation of the skin were noted. CT demonstrated two circular thickenings in the sigmoid and colon ascendens. …

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  • Competing interests None.

  • Patient consent Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.