A distinctive skin eruption following small-bowel by-pass surgery

Crops of distinctive skin lesions appeared after jejuno-ileal by-pass surgery for morbid obesity in three patients. They consisted mainly of large numbers of macules on the extremities, of vague outline and with a tendency to central pustulation and necrosis. Severe arthralgia and myalgia preceded the skin lesions, which histologically showed a dense neutrophil leukocytic infiltrate, nuclear debris, and fibrin deposition around blood vessels in the dermis.