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Recently I saw a patient who had experienced two consecutive days of pain in his right upper abdomen. I questioned him, looking for clues of gallstones, liver mass, or maybe an ulcer in the small bowel, but his answers did not fit my expectations. The pain was located under his right ribs and radiated into his back, just as I would expect of gallbladder disease; but it was not triggered by eating, and the way the patient described the pain did not fit the profile of an abdominal disorder. Then, a lightbulb went off; I needed to look at his skin.

I examined his right back, and sure enough th...