Track

Case Reports

Abstract

A 64-year-old man with a history of Roux-en-Y gastric bypass in 2023 was admitted to the hospital with recurrent red plaques and pustules of the right hand. Despite treatment with intravenous antibiotics as well as incision and drainage for presumed cellulitis, his symptoms continued to recur. A punch biopsy was performed, which revealed a diffuse dermal and subcutaneous neutrophil-rich mixed inflammatory infiltrate. Special stains were negative for infectious organisms. Given the patient’s history, the histopathologic findings were compatible with bowel-associated dermatosis-arthritis syndrome (BADAS), a rare neutrophilic dermatosis historically linked to bariatric surgery. It typically presents with flu-like symptoms and arthritis preceding an inflammatory skin eruption comprised of erythematous papules/plaques and pustules. The pathogenesis of BADAS is believed to involve bacterial overgrowth leading to immune complex formation and neutrophilic inflammation in the skin and joints. The diagnosis of BADAS can be challenging, as formal clinical diagnostic criteria does not exist for the condition and cutaneous findings can be inconsistent. Importantly, histopathology can crucially assist in the diagnosis. This case highlights BADAS as an important diagnostic consideration in patients with a neutrophilic dermatosis and a history of bariatric surgery. Evaluation for underlying gastrointestinal disease is recommended to further guide management.