Listen to Patient’s Gut: A Case Report of a Woman With Fatigue and Bruising

Abstract

A 65-year-old female patient with dermatomyositis and lipodystrophy presented with fatigue and severe anemia. Abdominal auscultation revealed a loud hum in the epigastrium, consistent with a Cruveilhier-Baumgarten murmur, typically associated with portal hypertension. Magnetic resonance imaging showed signs of portal hypertension, including recanalization of paraumbilical vein. Liver biopsy demonstrated sinusoidal dilation without cirrhosis, leading to a diagnosis of portosinusoidal vascular disease. Upper endoscopy confirmed portal hypertensive gastropathy as the cause of anemia. This case highlights the importance of a thorough physical examination in guiding subsequent imaging and diagnostic workup.