LAUSR

A woman aged 55 years presented to her general practitioner (GP) with a painful, rapidly progressing ulcer surrounding her ileostoma site. The lesion initially appeared one week prior as a ‘small pimple’. Physical examination revealed an ulcer measuring 8 cm × 5 cm. It had violaceous and undermined borders (Figure 1). The patient had a resection of her sigmoid colon, right hemicolectomy and end-ileostomy in 2015 for segmental colitis associated with perforated diverticular disease. In 2018, she developed colitis of the diverted colon, which was conservatively managed. She was classified as obese (class 3) because of a body mass index of 48 kg/m2. Her other medical history included osteoarthritis, non-alcoholic fatty liver disease, fibromyalgia and allergic rhinitis. Her medications included mesalazine (rectal), duloxetine, psyllium husk capsules, fexofenadine and oxycodone. She had medication allergies to sulfonamides and celecoxib. The GP referred the patient to the emergency department for further assessment and investigation, and she was subsequently admitted under the care of the gastroenterology team. Laboratory tests were unremarkable, apart from a mildly elevated C-reactive protein level (14 mg/L; reference range <6 mg/L). A punch biopsy of the ulcer edge showed a deep dermal neutrophilic dermatosis. Tissue culture and stains were negative for infective microorganisms.