Bleeding from a tuberculous gastric ulcer

A 26-yr-old male of Ecuadorian descent developed epigastric pain and bleeding per rectum, necessitating hospitalization. Upper endoscopy revealed an irregularly shaped gastric ulcer which was biopsied. Because of persistent bleeding and hemodynamic compromise, the patient underwent an exploratory laparotomy. Findings included peritoneal and visceral surfaces studded with small, round yellow lesions. Frozen section examination revealed granulomas with giant cells. Gastric biopsies from the endoscopy showed AFB. Although gastric involvement is seen in association with tuberculosis, the occurrence of upper gastrointestinal bleeding is unusual.