An uncommon presentation of a common pathogen

Question A 70-year-old woman presented with severe spasmodic abdominal pain, nausea, recurrent vomiting and mild diarrhoea. Two months earlier she underwent autologous stem cell transplantation for stage 2A follicular lymphoma. Her medical history was otherwise unremarkable. Physical examination revealed mild epigastric tenderness. Blood tests showed an elevated lactate dehydrogenase (325 IU/L; normal range 135–214 IU/L) and elevated transaminases (alanine transaminase 126 IU/L; aspartate transaminase 90 IU/L; normal range 10–35 IU/L). Blood cell counts were within the normal range. Ultrasound examination did not detect a cause for the abdominal pain. She was not on immunosuppressive therapy. Subsequently, the patient underwent upper endoscopy that revealed the presence of several protruding, ulcerative gastric lesions (figure 1A). The lesions were detected throughout the stomach while oesophagus and duodenum were spared. Biopsies of the gastric lesions were obtained for histological evaluation (figure 1B) and for microbiological analysis. Following 2 weeks of specific therapy, the gastric...
Source: Gut - Category: Gastroenterology Authors: Tags: GUT Snapshot Editor ' s quiz: GI snapshot Source Type: research