Article Text

Reminder of important clinical lesson
Analgesics are not always the culprits: isolated gastric fundal varices as the cause of recurrent upper GI bleed in a patient with SLE, rheumatoid arthritis and polymyositis overlap syndrome
  1. Abdul Majid Wani1,
  2. Waleed Mohd Hussain1,
  3. Mohamad Ibrahim Fatani1,
  4. Mazen G Bafaraj2,
  5. Khalid Showkat2,
  6. Sadia Hanif2,
  7. Ahmad Qadmani2,
  8. Mubeena Akhtar1,
  9. Ghassan Al Maimani3
  1. 1
    Hera General Hospital, Medicine, 4a/201, Hera General, Hospital, Makkah, Western, 21955, Saudi Arabia
  2. 2
    Hera General Hospital, Hera General Hospital, Makkah, 21955, Saudi Arabia
  3. 3
    Umul Qurah University, Umul Qurah University, Makkah, 21955, Saudi Arabia
  1. Abdul Majid Wani, dr_wani_majid{at}


The most common cause of upper gastrointestinal bleeding in patients with systemic rheumatic diseases is non-steroidal drug use; this is the case with COX-2 inhibitors, especially when used concomitantly with corticosteroids. Bleeding from varices is unusual in the absence of liver disease. We present an interesting case of a patient with systemic lupus erythematosus, rheumatoid arthritis and polymyositis overlap syndrome with recurrent upper gastrointestinal bleeds from isolated fundal gastric varices and a normal liver.

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  • Competing interests: none.

  • Patient consent: Patient/guardian consent was obtained for publication