Seen in up to 20 % of patients with jejunal-ileal bypass 3 months to 5 years following surgery; also associated with biliopancreatic diversion, Billroth II gastrectomy, occasionally inflammatory bowel disease (IBD), and rarely after laparoscopic gastric bypass surgery
Presents with flu-like symptoms of fevers, myalgia, and tenosynovitis with symmetrical small joint polyarthritis without deformities
Painful skin rash develops 12–36 h after flu-like symptoms with crops of small erythematous purpuric macules often on the upper trunk and extremities that progress to indurated, urticarial purpuric papules and then vesiculopustular lesions over the next 24–48 h. The lesions heal without scarring over the next 2 weeks.
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