Funky Rash in Nashville

A 17-year-old male adolescent presents to the emergency department with recurrent ulcerative skin lesions of the extremities, as well as weight loss, hematochezia, and postprandial abdominal pain. As diagnosis and treatment of dermatologic lesions are mainstays of pediatric emergency medicine, his initial presentation and broad differential provide valuable teaching lessons regarding the etiology and workup of ulcerative skin lesions. Following multiple long hospitalizations and extensive testing, the ultimate diagnosis was eventually revealed through attention to subtle details in the patient's history and presentation. A keen eye for similar presentations has the potential to provide future patients with less extensive workups, minimizing invasive patient testing and saving significant health care dollars.