General

Case Study - Haematology case

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8 Sep 2016 - General
 

A young gentleman, with Acute myleoid leukemia, around day 19 post bone marrow transplantation, complainted of worsening epigastric/retrosternal pain, reflux symptoms, on-going nausea with few occasion of vomitting for the last 1 week. Cardiac work ups for him were all unremarkable. Initially, he was given proton pump inhibitor once a day dose, with no improvement. The proton pump inhibitor dose was increased to twice daily dose, with minimal impact on the symptoms. He was referred for a gastrosocpy for further investigation for his on-going upper gastrointestinal symptoms. During the gastroscopy, a few oesophageal ulcers were detected on his lower oesophagus. Biopsy from the ulcer edge was taken. What will you differential diagnosis for the oesophageal ulcer ????

Usually transplant recipients are on a lot of anti-rejection medications. The first thing id ask would be what are the medications of this patient.Is he on steroid-free regimen? If not, what is the dose of his steroid treatment and how is he taking it? The combination of steroid, mycophenolate mofetil and even tacrolimus can have serious gastrointestinal side effect such as the development of ulcer. We also have to consider if this patient is on NSAID treatment and for how long because this can ...
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