A 36-Year-Old Man Arrives at the Clinic with a 2-Month

A 36-year-old man arrives at the clinic with a 2-month history of a pruritic rash on his elbows and knees. Despite utilizing skin emollients, the patient's lesions have not improved. He also has a history of intermittent stomach pain, gas, and profuse oily stools. The cardiopulmonary exam is normal. The abdomen is nontender and soft. A papulovesicular skin rash with erosion and excoriations is seen on skin inspection. Which of the following is the most likely in this patient?

A) Crypt abscesses in colonic mucosa
B) IgG-mediated skin disruption
C) Increased intestinal intraepithelial lymphocytes
D) Increased urinary porphyrins
E) Insulin resistance