A woman in her 30s with a 1-year history of unintentional weight loss, mild diffuse abdominal pain, and occasional episodes of vomiting presented to the emergency department with a 24-hour history of intense abdominal pain, fever, and loose stools. An abdominal computed tomographic scan showed findings consistent with bowel perforation, and she was admitted to the intensive care unit after emergent exploratory laparotomy.
Her medical history was significant for 1 other episode of idiopathic bowel perforation 3 years prior. She denied taking any medications. Dermatology was consulted to evaluate an asymptomatic skin eruption that had been present for at least 8 months before her hospitalization. Physical examination revealed numerous 5- to 10-mm nontender papules with a porcelain-white atrophic center and an erythematous halo, alongside scattered atrophic white scars (Figure, A and B). The lesions were distributed across her trunk, neck, and upper and lower extremities. Palms, soles, scalp, genitalia, and mucosal surfaces were spared. Her neurological and mental state examination had unremarkable results. Biopsy specimens from her thigh and back were obtained (Figure, C and D).