Gastrointestinal Manifestations of Dermatologic Disorders Helen M. Shields, Kitt Shaffer, Richard P. O’Farrell, Robin Travers, Jane N. Hayward, Laren S. Becker, Gregory Y. Lauwers  Clinical Gastroenterology and Hepatology  Volume 5, Issue 9, Pages 1010-1017 (September 2007) DOI: 10.1016/j.cgh.2007.05.018 Copyright © 2007 AGA Institute Terms and Conditions

Figure 1 Epidermolysis bullosa. (A) Close-up view of the foot of a 16 year old woman. Blebs at 3 different stages are seen. The most acute lesion (black arrow) shows a tense bleb at the site of minor trauma. A more subacute lesion (red arrow) shows a shallow ulcer with an erythematous base. The oldest lesion (white arrow) shows scab formation over the ulcer. (B) Endoscopic image of the esophagus with a discrete superficial ulcer (arrows). (C) Barium swallow showing a smooth stricture in the upper esophagus (white arrows) just below the level of the clavicular heads. There is food impacted above the stricture (black arrows). Clinical Gastroenterology and Hepatology 2007 5, 1010-1017DOI: (10.1016/j.cgh.2007.05.018) Copyright © 2007 AGA Institute Terms and Conditions

Figure 2 Systemic mastocytosis. (A) Typical skin findings with patchy erythema of the face and neck in a woman with nausea, vomiting, dyspnea, and systemic mastocytosis. (B) Colonic biopsy specimen showing infiltration of the mucosa by mast cells. Inset shows immunoperoxidase staining for tryptase. Clinical Gastroenterology and Hepatology 2007 5, 1010-1017DOI: (10.1016/j.cgh.2007.05.018) Copyright © 2007 AGA Institute Terms and Conditions

Figure 3 HHT (Osler–Weber–Rendu). (A) Frontal chest radiograph of a 68-year-old man with a history of HHT and anemia, showing tortuous and dilated vessels at the left lung base (arrows). (B) Axial chest CT image with intravenous contrast. Tortuous and dilated vessels consistent with an arteriovenous malformation are seen at the left lung base (arrows). Bilateral pleural effusions also are observed. (C) Axial abdominal CT image with intravenous contrast reveals an arteriovenous malformation of the left lobe of the liver characterized by the notably distended and irregular vessels (arrows). On auscultation, a bruit was heard over the liver. (D) Endoscopic image of the duodenum showing typical telangiectasia of HHT. (E) Frontal chest radiograph of the same patient as in panel A after embolization of the left lower lobe AVM with a coil (arrow) showing partial resolution of the AVM. Clinical Gastroenterology and Hepatology 2007 5, 1010-1017DOI: (10.1016/j.cgh.2007.05.018) Copyright © 2007 AGA Institute Terms and Conditions

Figure 4 Malignant melanoma. (A) Upright abdominal film in a 94-year-old man with abdominal pain showing multiple air fluid levels (arrows) in dilated small bowel. (B) Axial pelvic CT image with intravenous contrast reveals multiple dilated and fluid-filled loops of small bowel, including one loop in the right lower quadrant (white arrows) that contains central fatty density (black arrows) consistent with intussusception. (C) The resected portion of the ileum shows the intussusception (arrows) anchored on a distinctly pigmented mass lesion. (D) Histopathologic examination reveals the typical histologic features of malignant melanoma. (E) Image shows the characteristic S-100 immunohistochemical staining for melanoma. Clinical Gastroenterology and Hepatology 2007 5, 1010-1017DOI: (10.1016/j.cgh.2007.05.018) Copyright © 2007 AGA Institute Terms and Conditions