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Rwandan man with a case of the blues
  1. Benjamin Wipper1,
  2. Hanna Blaney2,
  3. Robert Giraneza3,
  4. Prosper Ingabire4,
  5. Vincent Dusabejambo4,
  6. Udit Asija5,
  7. Erik C von Rosenvinge2,6
  1. 1Harvard Medical School, Boston, Massachusetts, USA
  2. 2Division of Gastroenterology and Hepatology, University of Maryland School of Medicine, Baltimore, Maryland, USA
  3. 3Unit of Gastro-Intestinal Endoscopy, Department of Internal Medicine, University Teaching Hospital of Butare, Butare, Rwanda
  4. 4University of Rwanda College of Medicine and Health Sciences, Kigali, Rwanda
  5. 5Wright Center for Graduate Medical Education, Scranton, Pennsylvania, USA
  6. 6VA Maryland Health Care System, Baltimore, Maryland, USA
  1. Correspondence to Benjamin Wipper, Harvard Medical School, Boston, Massachusetts, USA; bwipper{at}hms.harvard.edu

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Introduction

A Rwandan man in his 40s underwent an upper gastrointestinal endoscopy for evaluation of solid-food dysphagia. Of note, the patient also reported a long-standing history of anaemia, which was originally diagnosed in 2000. He had required four transfusions since and noted that he had previously been prescribed tot’hema syrup (a form of iron supplementation) but was no longer taking it. Laboratory tests around the time of endoscopy showed microcytic anaemia (haemoglobin 99.1 g/L, median corpuscular volume 61.84 fL) with an elevated reticulocyte count (91×109/L). Further labs showed low serum iron (28 mcg/dL) and ferritin (20.5 ng/mL). The patient denied ever experiencing melena or haematochezia.

Endoscopic examination revealed a partially obstructing Schatzki’s ring as the explanation for his dysphagia and this was treated with balloon dilation. The endoscopy also revealed numerous blue-violet vascular-appearing …

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Footnotes

  • X @wipper_ben

  • Contributors BW was involved in patient interaction and data acquisition, contributed to the original conception of the case report and drafted the manuscript. HB and ECVR were involved in patient interaction and data acquisition, contributed to the original conception of the case report and revised the manuscript critically for important intellectual content. RG, PI and UA were involved in patient interaction and data acquisition and revised the manuscript critically for important intellectual content. VD played a critical role in making data acquisition possible and revised the manuscript critically for important intellectual content. All authors approved the final version of the manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.