Rwandan man with a case of the blues

A Rwandan man in his 40s underwent an upper gastrointestinal endoscopy for evaluation of solid-food dysphagia. Of note, the patient also reported a long-standing history of anaemia, which was originally diagnosed in 2000. He had required four transfusions since and noted that he had previously been prescribed tot’hema syrup (a form of iron supplementation) but was no longer taking it. Laboratory tests around the time of endoscopy showed microcytic anaemia (haemoglobin 99.1 g/L, median corpuscular volume 61.84 fL) with an elevated reticulocyte count (91×109/L). Further labs showed low serum iron (28 mcg/dL) and ferritin (20.5 ng/mL). The patient denied ever experiencing melena or haematochezia. Endoscopic examination revealed a partially obstructing Schatzki’s ring as the explanation for his dysphagia and this was treated with balloon dilation. The endoscopy also revealed numerous blue-violet vascular-appearing …