Footnotes

• Competing interests None declared.

• Patient consent Obtained.

• Provenance and peer review Not commissioned; externally peer reviewed.

• Data sharing statement I allow data sharing of the original article as needed by the EMJ. The data for this image challenge is available to me after looking after the patient personally and obtaining consent to publish the case from the patient. There is additional unpublished information of the case in my possession that has not been included due to word count restrictions.