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Upper gastrointestinal bleeding in a patient with AIDS.
Valeska Balderas1, Stuart Jon Spechler
1University of Texas Southwestern Medical Center, Dallas, TX, USA.
Summary
A patient with AIDS and hepatitis C presented with gastrointestinal bleeding. Diagnosis revealed stomach cancer (diffuse large B-cell lymphoma), which was treated with endoscopic intervention and proton pump inhibitors.
Area of Science:
- Gastroenterology
- Oncology
- Infectious Diseases
Background:
- A 38-year-old male with advanced HIV/AIDS and hepatitis C infection presented with acute gastrointestinal bleeding.
- The patient had a history of poor adherence to highly active antiretroviral therapy (HAART) and denied nonsteroidal anti-inflammatory drug (NSAID) use.
Observation:
- Clinical presentation included epigastric pain, odynophagia, and melena.
- Physical examination, stool guaiac testing, and laboratory investigations were performed.
- Esophagogastroduodenoscopy revealed gastric ulcerations.
Findings:
- Biopsies confirmed diffuse large B-cell lymphoma of the stomach.
- The lymphoma was associated with significant gastric ulceration and bleeding.
- Endoscopic interventions included epinephrine injection and bipolar coagulation for hemorrhage control.
Implications:
- This case highlights the importance of considering gastric lymphoma in immunocompromised patients presenting with upper gastrointestinal bleeding.
- Effective management involved a combination of endoscopic hemostasis and proton pump inhibitor (PPI) therapy.
- Further research into the oncogenesis and optimal treatment strategies for gastric lymphoma in the context of HIV/AIDS is warranted.