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An uncommon presentation of a common pathogen
  1. Tobias Boettler1,
  2. Lisa Lutz2,
  3. Nathalie Schmidt1,
  4. Robert Thimme1,
  5. Christoph Neumann-Haefelin1
  1. 1Department of Medicine II, University Hospital Freiburg, Freiburg, Germany
  2. 2Department of Pathology, University Hospital Freiburg, Freiburg, Germany
  1. Correspondence to Dr Tobias Boettler, University Hospital Freiburg, Department of Medicine II, Hugstetter Str. 55, Freiburg D-79106, Germany; tobias.boettler{at}

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A 70-year-old woman presented with severe spasmodic abdominal pain, nausea, recurrent vomiting and mild diarrhoea. Two months earlier she underwent autologous stem cell transplantation for stage 2A follicular lymphoma. Her medical history was otherwise unremarkable. Physical examination revealed mild epigastric tenderness. Blood tests showed an elevated lactate dehydrogenase (325 IU/L; normal range 135–214 IU/L) and elevated transaminases (alanine transaminase 126 IU/L; aspartate transaminase 90 IU/L; normal range 10–35 IU/L). Blood cell counts were within the normal range. Ultrasound examination did not detect a cause for the abdominal pain. She was not on immunosuppressive therapy.

Subsequently, the patient underwent upper endoscopy that …

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