A 77-year-old woman presented with dyspnea and melena. Laboratory testing showed anemia (hemoglobin 7.5 g/dL, MCV 92 fL) with low ferritin and vitamin B12 levels. Endoscopy revealed longitudinal antral telangiectatic stripes (“watermelon stomach”) consistent with gastric antral vascular ectasia (GAVE) and corpus-predominant atrophy (Picture A-C). Helicobacter pylori IgG was ＜3 U/mL, and both the anti-intrinsic factor and anti-parietal cell antibodies were positive, with marked hypergastrinemia (fasting gastrin, 3,520 pg/mL). These findings are consistent with autoimmune gastritis. An antinuclear antibody (speckled, 1:160) prompted a workup, confirming limited cutaneous systemic sclerosis with RNA polymerase III antibodies, sclerodactyly, and interstitial lung disease (Picture D). She underwent argon plasma coagulation for GAVE and received iron and vitamin B12, which corrected her anemia. In systemic sclerosis, GAVE causes blood loss and is correlated with RNA polymerase III antibodies (1), whereas autoimmune gastritis is uncommon (2). Their coexistence can lead to both combined iron and vitamin B12 deficiencies, thereby warranting evaluation for systemic autoimmunity and both deficiencies.
Picture A.
Picture D.
Picture B.
Picture C.
The authors state that they have no Conflict of Interest (COI).
References
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