38 years-old man with personal history of drug addiction in the past, VIH1 and VHC Infection, cerebral toxoplasmosis, pulmonary tuberculosis, and uveitis in the previous year (diagnosis made by an Ophthalmologist). The patient proceeded to the emergency department with abdominal pain, and vomiting, in the previous 24h. On examination, his vital signs were stable, but he presented an acute abdomen with peritoneal rebound. He revealed also maculo-pustular lesions in the limbs. The laboratory results of the patient showed no anemia, an elevated leukocyte count and a high C-reactive protein (Hb 13.3g/dL, WBC 7300, Plat 112000. CRP 1.81mg/dl). We started the approach by asking a thoracic radiography that showed a pneumoperitoneum (Figure 1, Figure 2). This way, an urgent CT scan revealed signs of pneumoperitoneum with "intra-peritoneal fluid specially in the pelvic cavity and an extension of thickened small bowel". In the same exam we found a small "collection of enteric fluid" (Figure 3, Figure 4). The patient underwent a laparotomy where we found a multi-segmental disease with multiples stenosis, one of which was perforated. We proceed to the resection of that segment of small bowel and a termino-terminal anastomosis. He was asymptomatic at the time of discharge from hospital. Histology revealed "small areas of mucosal necrosis, lacerations and perforations, and an important granulocytic inflammation (...) focal proliferation of capillaries which are in marked stasis. Venous congestion in mesenteric vessels. These aspects should be contextualized with the clinic, imaging and systemic study of the patient but are suggestive of Behcet's syndrome (ischemic ulcerations)" (Figure 5).