MASSIVE BLEEDING FROM MULTIPLE GASTRIC ULCERATIONS IN A PATIENT WITH LYMPHOCYTIC GASTRITIS AND CELIAC SPRUE

Uncontrolled hemorrhage and multisystem organ failure developed in a p atient with celiac sprue, lymphocytic gastritis, and diffuse gastric u lceration. A proximal small bowel biopsy showed villous atrophy and ly mphoplasmacytic infiltration consistent with celiac sprue. At autopsy, there were no gross or histologic findings to suggest lymphoma. The i ntestinal lymphocytic infiltrate was not monoclonal, and gene rearrang ements were not detected. Lymphocytic gastritis is a rare cause of upp er gastrointestinal hemorrhage, which may be the result of sensitivity to gluten or other luminal antigens. This diagnosis should be conside red in cases of diffuse gastric ulceration with bleeding in which the endoscopic appearances are not typical of peptic ulcer disease or drug -induced erosions. ideally, biopsies of gastric and duodenal mucosa sh ould be performed to establish the diagnosis.