Melena: a rare presentation of childhood Burkitt's lymphoma.

abdominal pain not associated with meals. He had had 3 melena stools and 2 episodes of nonbilious, non-bloody emesis. He reported no NSAID use, weight loss or fever and had no history of excessive bleeding or of gastrointestinal or liver disease. The patient was pale, afebrile and hemodynamically stable. His abdomen was soft and diffusely tender, with no rebound tenderness or guarding. There was no lymphadenopathy, hepatosplenomegaly or abdominal mass. A complete blood count showed a hemoglobin concentration of 80 (normal 120–160) g/L and a normal platelet count. The international normalized ratio, partial thromboplastin time, electrolyte levels, and renal and liver function test results were normal. Upper endoscopy revealed multiple ulcerated masses in the stomach, duodenum and jejunum that were suggestive of cancer (Fig. 1). CT scans of the chest and abdomen showed multiple lesions in the liver, kidneys, pancreas, stomach and small bowel (Fig. 2 and Fig. 3) and significantly enlarged lymph nodes in the retroperitoneum, crural area and inguinal canal. Immunohistochemical staining of the biopsied gastric lesions identified Burkitt’s lymphoma. The patient was initially given a proton pump inhibitor intravenously and then combination chemotherapy. He responded rapidly and remains in remission 1 year after completing the treatment. Melena: a rare presentation of childhood Burkitt’s lymphoma