PMC9618646_01
(a) Numerous yellow-white tubercles were interspersed on the surface of small intestine. (b) Generalized skin emption with porcelain - white centers surrounded by erythematous borders. (c) The white arrow shows free air around the intestine. (d) The black arrow shows one of the perforations of the small intestine. (e) The biopsy of skin eruption showed atrophy of epidermis, hyperplasia and collagen of dermal fibrous tissue. (f) Histopathologic result of the resected intestine showed acute and chronic inflammatory cell infiltration.
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F1
Intraoperative findings revealed that numerous 0.2-0.4 cm yellow-white tubercles were interspersed on the surface of congestive small intestine, colon, appendix, greater omentum and mesenterium, especially the distal ileum (Figure 1a), without apparent perforation. Meanwhile, generalized skin eruptions with an atrophic porcelain-white center surrounded by erythematous rim were visible over trunk and extremities, measuring 0.2-1.2 cm (Figure 1b). Computed tomography showed a small amount of free air bubble, edema and thickening of the small bowel wall and massive seroperitoneum (Figure 1c). In the operation, we found more than 100 whitish-yellow plaques, dozens of intestinal perforations and purulent materials (Figure 1d). Biopsy of skin eruption was conducted and the pathology showed atrophy of epidermis, hyperplasia and collagen of dermal fibrous tissue, degeneration of elastic fibers, significantly reduction and partial necrosis of skin appendages, fibrinoid necrosis in small vessels of the deep dermis and thrombosis in local lumen (Figure 1e). Histopathology of the resected intestine showed edema and hyperaemia, thrombus organization of both tiny artery and veins lumen with acute and chronic inflammatory cell infiltration (Figure 1f).