Complex Presentation of a Dieulafoy Lesion in a Geriatric Patient with Multiple Comorbidities.

Dieulafoy lesions (DL) consist of tortuous, thick-walled submucosal arteries that protrude through a small mucosal defect, often surrounded by otherwise normal mucosa. They are commonly located in the proximal stomach, particularly along the lesser curvature and near the esophagogastric junction, typically within 5 cm. However, they can also occur in various other regions of the GI tract, including the esophagus, duodenum, and colon. We present the case of a 76-year-old female with a complex medical history who arrived at the ED with hematemesis and melena. Her condition rapidly deteriorated; her blood pressure significantly dropped. Upon stabilization, upper endoscopy uncovered a 5-cm red lesion near the gastroesophageal junction, indicative of DL. Immediate intervention with clips was successful. Following the procedure, while the patient was in the ICU, she started to experience left-sided chest pain and diaphoresis, leading to the suspicion of acute coronary syndrome. Further investigations revealed non-ST-elevation myocardial infarction (NSTEMI). This case highlights the life-threatening nature of upper GI bleeding, especially in elderly patients with multiple comorbidities and extensive medication regimens. Timely diagnosis and intervention for DL are crucial, particularly in elderly patients with multiple health comorbidities. This underscores the significance of prompt medical attention and intervention in such complex scenarios.

Solitary Plasmacytoma in the Calcaneus.

Solitary plasmacytomas (SPs) are tumors characterized by local monoclonal plasma cell proliferation, presenting without systemic manifestations. It mainly affects the axial skeleton, with calcaneal involvement being extremely rare. We report a case of a 48-year-old patient with a history of gunshot injury to his foot who presented with worsening heel pain and a calcaneal cyst. Biopsy revealed plasmacytoma, and subsequent 18F-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) scan further supported the diagnosis of solitary plasmacytoma of the bone (SPB). Management included lesion excision, bone cement placement, and radiotherapy. However, due to recurrent osteomyelitis following cement placement, the patient eventually required total calcanectomy. SPB usually affects older adults, and developing the disease at a young age and in the calcaneus is exceedingly uncommon. Trauma is implicated as a possible inciting trigger in the pathogenesis of SPB without a clear association. This case highlights the importance of developing our current understanding of the clinical presentation and manifestations of SPB, beyond the conventional assumption that it only affects the axial skeleton of older individuals.