Challenging differential diagnosis, Rare co-existance of disease or pathology
Prashant Gupta, Madhu Suryadevara, Avash Das, James Falterman
(Department of Medical Education, Preventive Compliance Solutions, Broussard, USA)
Am J Case Rep 2015; 16:733-736
Cameron lesions are linear gastric erosions on the mucosal folds at the diaphragmatic impressions found in patients with large hiatal hernias. While usually asymptomatic, hiatal hernias can result in serious sequelae, as this case report will clearly illustrate. Cameron lesions are clinically significant because of their ability to cause significant acute, chronic, or obscure gastrointestinal bleeding, often requiring blood transfusions.
CASE REPORT: In this report, we present the case of a 51-year-old white woman who originally presented to the Emergency Department with complaints of a runny nose, dry cough, generalized weakness, and muscle cramping ascribed to a viral infection. However, closer examination revealed substantial pallor with pale conjunctiva prompting further workup that revealed substantial anaemia. Upon further inquiry of her past medical history, she revealed the need for previous blood transfusions, and meticulous review of her medical record indicated a previous diagnosis of hiatal hernia with the presence of Cameron lesions based on esophagogastroduodenoscopy 2 years prior.
CONCLUSIONS: This case emphasizes the need for a high index of suspicion for Cameron lesions as a causative agent of substantial blood loss in patients with hiatal hernias after other common causes of gastrointestinal bleeding have been ruled out.
Keywords: Diagnosis, Differential, Anemia - etiology, Endoscopy, Gastrointestinal, Female, Hernia, Diaphragmatic - diagnosis, Humans, Middle Aged, Severity of Illness Index, Stomach Ulcer - diagnosis