Severe anemia in a patient with vulvar melanoma

We report the case of a 78-year-old woman with a history of surgical excision of vulvar melanoma (VM; stage IV c-Kit ex-17 mutated) who developed lung and nodal metastases, achieving 9-month complete response from anti-PD1 MoAb. She gave written consent for this publication; ethics committee approval was waived because of the case report format. Subsequently, the onset of fatigue associated with severe anemia (up to Hb 7.5 g/dL) occurred. Gastroscopy, colonoscopy, and hematologic investigations, such as bone marrow biopsy, were negative. The computed tomography scan showed an unspecific dilatation of the small bowel loops without air fluid levels. Based on these findings, she underwent video capsule endoscopy, showing an irregular, hyperemic, bloody, and pigmented ulcer of the first jejunal loop.