A 12-year-old girl presented with midepigastric and right-upper-quadrant abdominal pain of 4 weeks' duration. Often, pain was present in the morning and persisted all day. Occasionally it awakened her at night. Antacids provided temporary relief of pain, but when symptoms persisted, she was referred to a gastroenterologist. There was no nausea, vomiting, hematemesis, or diarrhea. Results of physical examination were normal. However, a small amount of stool that tested positive for occult blood was found on rectal examination. Her hematocrit was 0.35, and results of a complete blood count were within normal limits. An upper gastrointestinal series with air contrast showed thickened gastric folds (Fig 1). Endoscopy of the upper gastrointestinal tract showed diffuse erythema of the gastric mucosa and small petechial hemorrhages in the body of the stomach. The antrum demonstrated fine nodules, and the duodenum was erythematous, with two small ulcerations. Endoscopic biopsy specimens were taken (Figs 2
Dahms BB, Morrison SC, Gilbert-Barness E. Pathological Cases of the Month. Am J Dis Child. 1993;147(3):315–316. doi:10.1001/archpedi.1993.02160270077025
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