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Community hospital gastroenterologists and endoscopists should be aware that Dieulafoy's lesions are an uncommon cause of upper GI bleeding among elderly patients. Early accurate diagnosis through emergent endoscopy and endoscopic therapy, especially in patients with multiple co-morbid conditions, can be very effective and life saving.

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A 47−year−old Hispanic man who had no significant past medical history was ad− mitted to the Wyckoff Heights Medical Center with nausea and headache, which were followed by seizures. The patient had had significant weight loss and an ab− dominal computed tomographic scan re− vealed thickening of the stomach wall (l " Figure 1). The patient initially refused upper endoscopy but agreed to undergo video capsule endoscopy, which showed lesions suggestive of Kaposi's sarcoma in the small bowel (l " Figure 2). He subse− quently agreed to undergo upper endos− copy for biopsy of the lesion and this ex− amination revealed purplish nodular le− sions in the esophagus, stomach, and duodenum. Push−enteroscopy showed typical Kaposi's lesions in the jejunum (l " Figure 3). A biopsy of one of the le− sions showed spindle−cell proliferation with vascular splits, an appearance con− sistent with a diagnosis of Kaposi's sarco− ma (l " Figure 4). Immunohistochemical testing for human herpesvirus 8 (HHV−8) showed a strong positive reaction (l " Fig− ure 5). The patient was subsequently found to have a very low absolute CD4 count and he tested positive for human inmmunodeficiency virus, with a high viral load. The patient was started on highly active antiretroviral therapy (HAART) and was feeling much better when seen on follow−up 2 weeks later.

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