Radiology: Volume 245: Number 3-December 2007
Pamela T. Johnson, MD Karen M. Horton, MD Elliot K. Fishman, MD
History: A 37-year-old man presented to his physician with sharp and continuous upper abdominal pain. Upper endoscopy was performed for evaluation and revealed Helicobacter pylori-negative gastritis. Treatment with a proton pump inhibitor failed to alleviate his symptoms. The patient subsequently developed diarrhea and dark stools, followed by a petechial rash that involved his lower extremities. At this point, he was admitted to an outside hospital for evaluation. Colonoscopy and repeat endoscopy revealed nothing that could account for his symptoms. After an observation period, he was discharged.
The patient's abdominal pain persisted and worsened. In addition, he felt feverish and developed joint pain, which was most severe in his knees and wrists. Three weeks after the initial episode, he was readmitted to the hospital with intractable abdominal pain and new onset of vomiting. At admission, a petechial rash with regions of purpura was noted on his thighs and calves. A similar rash with a maculopapular appearance was apparent on his upper extremities. Laboratory tests revealed an elevated erthro-cyte sedimentation rate and a minimally elevated platelet count. Antinuclear antibody test results were negative. Intravenous contrast material-enhanced multidetector computed tomography (CT) of the abdomen and pelvis was performed the next day, with 120 mL of iohexol (Omnipque 350; GE Healthcare, Princeton, NJ) infused at a rate of 3 mL/sec.