Case
A 41-year-old Tunisian male diagnosed with an acute lymphoblastic
leukemia was admitted to our hospital for a chemotherapy cure
(Hyper-CVAD: Cyclophosphamide,
Vincristine
Sulfate,
Doxorubicin
Hydrochloride and
Dexamethasone).
During the hospitalization, he presented an acute epigastric pain with
hemodynamic instablility and fever. Physical examination revealed
abdominal tenderness. The thoroco-abdominal CT scan showed
circumferential gastric thickening with an enhancement defect suggestive
of gastric ischemia associated with segmental pulmonary embolism (Figure
1). He was treated with noradrenaline, intravenous fluids, intravenous
proton pump inhibitors, broad-spectrum antibiotics and anticoagulants
with favorable clinical outcome. At day 7, he underwent an upper
endoscopy. It revealed hypertophic, ulcerated fundic folds covered with
false membranes with necrotic foci, extending from the proximal body to
the proximal antrum (Figure 2). Histology was compatible to the
endoscopic suspicion of gastric ischemia. The patient was discharged
after 2 weeks of medical treatment and was reevaluated at 1 month,
remaining asymptomatic.