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Case 6
“Skin lesions”
Natalia Dogliani – Alba Hospital
(Pictures by Dr. Dogliani)
Clinical history
34 y.o. woman.
July 2004: resection of perforated ileal ansa. Referred presence of maculopapular skin lesions, since two years, extending to the trunk and limbs. Ulceration and cicatricial involution tendency. Clinical diagnosis of chronic lichenoid pityriasis, treated with cortisone, antibiotics and PVA. During the postoperative appearance of ptosi in the eyelids.
November 2004: second ileal perforation, patient underwent surgical resection. During the hospitalisation a biopsy of one of the skin lesions was performed (Pict. 1) with subsequent definition of the illness.
September 2005: hospitalisation for “Paraparesis of lower limbs with limpness”. Eyesight trouble with foci of retinal ischemia.
October 2005: another ileal perforation, patient underwent a third surgical resection. During the postoperative, pleuropneumonia with left pleuric effusion and septic state.
Exitus.
Macroscopical description of ileum
Ileal segments with perforated walls, opaque serosa with multiple yellowish spotting.
Microscopical description
Mucosal ulceration on the edge of the perforated wall (Pict. 2). Accumulation of foamy histiocytes in the outer layers of the leiomuscular tunica (Pict. 3) and in the lumen of the arterial vessels of small to medium calibre with subsequent thrombosis of the lumen and ischemic damage to the intestinal wall (Pict. 4).
Microscopical description of the skin
Skin invagination in correspondence to cuneiform areas of derma sclerosis (Pict. 5), subsequent atrophy of the epidermis and ulceration of the skin (Pict. 6).
Diagnosis
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