MRCP2-2435

MRCP2-2435

A 32 year old man presents to the emergency department with central abdominal pain and vomiting that is unresponsive to IV morphine. He has been seen by surgeons earlier in the day for an acute abdomen, but a CT scan and blood tests revealed no surgical cause for his symptoms. Interestingly, the patient has presented to the emergency department five times in the past two years with similar problems, but no cause has ever been found and he was discharged with analgesia after a day or two. On examination, the patient has a generally tender abdomen with voluntary guarding and a rash on the back of his hands, neck, and cheeks consisting of several small fluid-filled bullae. His past medical history includes depression treated with citalopram and a short psychiatric inpatient stay for an episode of psychosis. What is the most likely diagnosis?