Medical image of the week: diffuse gastric bleeding and ALL

Abstract

No abstract available. Article truncated at 150 words. A 26-year-old man with a medical history significant for acute lymphoblastic leukemia (ALL) presented with hypovolemic shock secondary to large volume hematemesis. The patient was diagnosed with ALL and treated with high dose chemotherapy followed by peripheral blood stem cell transplant from a matched unrelated donor one year prior to presentation. His treatment course was complicated by grade 4 acute graft versus host disease (GVHD) and CMV colitis. Blood work on admission showed hemoglobin of 6.4 g/dL and a leukocytosis. Patient was intubated for airway protection, transferred to ICU, and EGD was performed, which revealed diffusely friable mucosa, inflammation, and ulcerations throughout the gastric mucosa with only a few areas of normal appearing mucosa. Additionally, areas of spontaneous bleeding were seen. Selective arteriography within the right gastric and gastroduodenal arteries showed no active extravasation from the stomach or duodenum. However the gastroepiploic and right gastric arteries were prophylactically embolized. Subsequently ...

Keywords

• ALL
• acute lymphoblastic leukemia
• gastrointestinal
• bleeding
• GI
• GVHD
• graft versus host disease
• stem cell
• transplant
• cytomegalovirus