A 68 year old fisherman presented with a two day history of severe epigastric pain. He also complained of fever and myalgia. He was transferred to a tertiary center for exclusion of a malignant gastric ulcer. He had not taken any anti-ulcer medication or nonsteroidal anti-inflammatory drugs (NSAID) prior to hospitalization. His vital signs were: blood pressure 120/80 mm Hg, pulse rate 80 beats per minute, respiration rate 20 breaths per minute, and body temperature 38.5°C. On physical examination, epigastric tenderness without rebound tenderness was observed, and an eschar was seen at the posterior neck. There was no other skin rash.

Investigations included a leukocyte count of 7640/µL, hemoglobin 12.8 g/dL, platelet count 189,000/µL, www.selleckchem.com/products/CAL-101.html blood urea nitrogen 17 mg/dL, serum creatinine 0.8 mg/dL, aspartate aminotransferase (AST) 162 IU/L, alanine aminotransferase (ALT) 172 IU/L, and total bilirubin 0.3 mg/dL. selleckchem Upper GI endoscopy revealed multiple irregular shaped ulcers and erosions with circumferential arrangement. (Figure 1) Multifocal hyperemic petechiaes in the duodenal bulb

were also present (Figure 2). Histopathologic findings showed diffuse infiltration of inflammatory cells without malignant cells. The immunofluorescent antibody test for O. tsutsugamushi was positive with a titer of 1:20,480, which confirmed the diagnosis of scrub typhus. The patient was treated with doxycycline 100 mg PO twice daily and pantoprazole 40mg PO once daily. One day after the commencement of medical therapy, the fever improved and the epigastric pain subsided. Although skin rash and eschar

are typical physical findings related to vasculitis resulting from scrub typhus infection, mucosal damage of the gastrointestinal tract may develop. The major endoscopic features include petechiae, superficial hemorrhage, erosions and ulceration with or without bleeding. Upper GI endoscopy should be considered for the early diagnosis and subsequent management of patients with severe GI symptoms, particularly if there is an eschar. Telomerase In addition to appropriate antibiotic therapy, antiulcer medications according to the severity of endoscopic findings may be very helpful to relieve the symptoms. Contributed by “
“Jay Donald Ostrow (Fig. 1) suddenly and unexpectedly passed away on January 9, 2013 at the age of 83. Don was born in New York, NY on January 1, 1930. Don obtained his BS in Chemistry at Yale in 1950 and his MD degree at Harvard 4 years later. He then went to the University College in London in 1969-1970 where he obtained the title of Magister Scientiae in Biochemistry in 1970 under the tutelage of Barbara Billing. His postgraduate training exposed him to the best of medical training, moving from Johns Hopkins to Harvard Medical School where he became chief research fellow in the laboratory directed by Rudi Schmid, one of the fathers of modern bilirubin science.