Print Email
 

Clinical Images

101 Dalmatians: What Are These Dots?

An 84 year-old female with Barrett’s esophagus and remote history of right toe amputation due to metastatic carcinoma was admitted for failure to thrive, presenting as nausea, vomiting, anorexia, and constipation with an associated episode of bloody emesis. Initial laboratory data was consistent with anemia (hemoglobin of 9.8g/dL and hematocrit of 27.9%, down from a baseline of 11g/dL and 32% four months prior). Further work up showed anemia of chronic disease with iron level of 14 ug/dL. She underwent upper endoscopy which showed a lesion within her known Barrett’s esophagus (Figure 1).  There were numerous variable-sized, black-pigmented mucosal lesions also noted in the duodenum and ileum (Figures 2 and 3). 

101-Dalmations_Figure-1_Ajayi.jpg

Figure 1

 

101-Dalmations_Figure-2_Ajayi.jpg

Figure 2

 

101-Dalmations_Figure-3_Ajayi.jpg

Figure 3

 



Click here to view the answer

References

1. Uchiyama S, Imamura N, et al. Late recurrence of malignant melanoma in the duodenum. Hepatogastroenterology. 2008 Sep-Oct; 55(86-87):1619-21.
2. Chang AE, Karnell LH, Menck HR. The National Cancer Data Base report on cutaneous and noncutaneous melanoma: a summary of 84,836 cases from the past decade. The American College of Surgeons Commission on Cancer and the American Cancer Society. Cancer 1998; 83:1664.



Author Biographies

Tokunbo Ajayi is a chief resident in the Department of Medicine at North Shore Medical Center (NSMC) in Salem, Massachusetts.  He attended medical school at the Obafemi Awolowo University, Ile-Ife, Nigeria. 

Nicholas Karamitsios is a gastroenterologist in the Department of Gastroenterology at North Shore Medical Center (NSMC) in Salem, Massachusetts.  He attended the Boston University School of Medicine and completed his gastroenterology fellowship at the University of Massachusetts Medical Center.

Han Jeppesen is the Director of Hospital Medicine at North Shore Medical Center (NSMC) in Salem, Massachusetts.   He completed his internal medicine residency at the University of Minnesota Medical School.



 

Submit content to JGIM

JGIM encourages submission of articles aimed at improving patient care, education, and research in primary care and general internal medicine in all settings. Submissions must be original and not currently under consideration for publication in another peer- reviewed medium (paper or electronic).

Learn How to Submit Here

 

FEATURED ARTICLE

 

Darlyn Victor, MD, Paul Moots, MD and Jacqueline Fischer, MD

October 13, 2016

A 39-year-old African-A....

Read Article
 

Most Viewed Articles

73 Views

The Role of Community-Based Participatory Research to Inform Local Health Policy: A Case Study.

O’Brien, Matthew J.; Whitaker, Robert C.

Read Article| Download PDF
25 Views

The Role of Community-Based Participatory Research to Inform Local Health Policy: A Case Study.

O’Brien, Matthew J.; Whitaker, Robert C.

Read Article| Download PDF
31 Views

The Role of Community-Based Participatory Research to Inform Local Health Policy: A Case Study.

O’Brien, Matthew J.; Whitaker, Robert C.

Read Article| Download PDF

Most Recent Web Only Content

January

17

On the Penetrating Capacity of Ultrasound

Sarah Bugg

Read Article

December

20

Painful Eruption in a Mountain Biker

Jasna Ikanovic, MD and Animita Saha, MD

Read Article

November

19

Adverse Events In US Hospitals:1 in 3 Admissions Has At Least One Adverse Event

SGIM Evidence-Based Medicine Task Force

Read Article

August

25

Diagnostic Schema

Denise M. Connor, Rabih Geha, Mark Henderson, Jeff Kohlwes

Read Article