To the Editor.—
We read the excellent case report by Fenske et al1 in the August Archives of a patient with ulcerative colitis who had an evanescent, vesiculopustular eruption with a clinical course paralleling that of his gastrointestinal tract disease. We2 recently described four patients with bowel-bypass syndrome without bowel bypass and on further evaluation have categorized these cases as pustular vasculitis of bowel disease.3 The combination of pustular cutaneous lesions on purpuric bases in a truncal distribution with serum sickness-like symptoms and cutaneous histopathologic findings of "Sweet's-like" dermal changes in patients with bowel disease define the syndrome.Fenske and his group have carefully considered a wide differential diagnosis in their patient. The clinical photographs were reminiscent of our patients (two of whom had inflammatory bowel disease). The published dermatopathology photographs of Fenske et al primarily show the epidermis, however, a "perivascular mixed infiltrate of neutrophils, histiocytes,
Jorizzo JL, Solomon AR, Subrt P. Vesiculopustular Eruption of Ulcerative Colitis. Arch Dermatol. 1984;120(9):1140. doi:10.1001/archderm.1984.01650450022009
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