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Quiz Case

Eruption in a Patient With Crohn Disease

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Figure 1.

Figure 2.

Figure 3.

A 53-year-old white man presented with an acute onset of inflammatory papulopustules on the central part of his face (Figure 1) and head (Figure 2) and a few lesions on his trunk that fused and discharged purulent material. Marked erythema, facial edematous swelling, and bilateral conjunctival injection were evident. Comedones were not observed.

The patient's medical history included type 1 diabetes mellitus and steroid-dependent Crohn disease, which was treated with prednisone (40 mg/d) and adalimumab (80 mg every 15 days for 2 months). He had no recent changes in medications or dosage. Physically, he felt well, and his gastroenterological examination did not show any exacerbation of his Crohn disease. Laboratory tests demonstrated mild leukocytosis and elevated eosinophil and C-reactive protein levels. The results of all other laboratory investigations were within the normal range. Repeated bacteriological investigations revealed that the purulent discharge was sterile. Histologic analysis was performed with hematoxylin-eosin staining (Figure 3).

See the full article for an explanation and discussion.

For comments or suggestions about the JAMA Dermatology Clinical Challenge, please contact us at jama-comments@jamanetwork.org.
Ashish Bhatia, MD, Web Editor, JAMA Dermatology.