2017-09-27 12:45:59 UTC

Image Challenge: Chronic Abdominal Pain and Cutaneous Swelling

Sept. 27, 2017

What caused five to eight week episodes of intermittent abdominal pain, diarrhea, and associated nontender, non-itchy cutaneous erythema and swelling in patient?

Gastroenterology Clinical Image Challenge: A 51-year-old man was referred to our tertiary medical center for a three-year history of intermittent abdominal pain, diarrhea, and associated nontender, non-itchy cutaneous erythema and swelling of his upper and lower extremities (Figure A) and scrotum. Each episode lasted for five to eight weeks before resolution. Medical history included gastroesophageal reflux disorder (on pantoprazole 40 mg/d) and essential hypertension (on losartan 50 mg/d for the past three years). Previous workup included unremarkable findings in esophagogastrnoduodenal scope and colonoscopy examinations within past one year.

An abdominal examination was remarkable for mild periumbilical tenderness. A contrast-enhanced computed tomography (CT) scan of abdomen and pelvis showed segmental jejunal wall thickening (arrow) suggestive of jejunal enteritis or edema (Figure B). Tests for serum tryptase and C4 and C1 esterase inhibitors were negative.

What is the diagnosis?

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