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Background
Acute gastrointestinal (GI) bleeding is a potentially life-threatening abdominal emergency. Bleeding from the upper GI tract is approximately four times more common than the lower GI tract and is a major cause of morbidity and mortality. 1 Mortality from upper GI bleeding are 6%-10% overall. 1 Sometimes patient underwent extensive evaluations by multiple specialists, but no definitive diagnosis was made. In this case report, patient presented with a very uncommon cause of life-threatening acute upper GI bleeding.
Case presentation
On 13 August 2010, a 33-year-old man presented with recurrent passage of black tarry stool for last 1 month. He was a known case of rheumatoid arthritis for last 5 years and was on oral non-steroidal anti-inflammatory drugs (NSAIDs), prednisolone and methotraxate. On admission, clinical examination revealed that he had features of drug induced Cushing's syndrome with severe anaemia and oral candidiasis. Other clinical examinations revealed normal findings. Our provisional diagnosis was rheumatoid arthritis with drug induced Cushing's syndrome with drug induced upper GI bleeding with oral candidiasis.
Laboratory test results showed haemoglobin 4.82 g/dl, haematocrit 15.42% and peripheral blood film showed microcytic hypochromic anaemia. All other biochemical test and HIV screening revealed normal findings. Upper GI endoscopy showed an annular shaped ulcer in the antrum near the pyloric ring with active bleeding. Inj. Proton Pump inhibitor, blood transfusion and other supportive management started and gradually oral prednisolone was withdrawn. Even after 4 days, clinical improvement did not occur, so anti Helicobacter pylori therapy (omeprazole, clarithromycin, amoxicillin) was started for 7 days as this infection is very common in...