title: [A rare cause of variceal bleeding].
abstract: BACKGROUND
  Agnogenic myeloid metaplasia (AMM) is a clonal stem cell disease, which is characterized by myelofibrosis, osteosclerosis and pancytopenia. Affected patients frequently develop portal hypertension secondary to extramedullary hematopoiesis, which rarely becomes clinically relevant.
  
  
  METHODS
  We here report on a 63-year-old patient with a first presentation of variceal bleeding. The patient was diagnosed with portal hypertension and due to marked splenomegaly, liver cirrhosis was suspected. Subsequently, an extramedullary hematopoiesis and AMM could be diagnosed. The variceal bleeding was initially treated endoscopically. The patient has received cytoreductive therapy and a splenorenal shunt, which has led to remission and long-term survival.
  
  
  CONCLUSIONS
  Agnogenic myeloid metaplasia is a rare cause of portal hypertension and may present with variceal bleeding. Clinicians should be aware of this rare cause of portal hypertension, as treatment of the underlying disease with cytoreductive therapy and appropriate management of portal hypertension may lead to long-term survival.
authors.affiliation: Medizinische Klinik und Poliklinik, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany. naderi.jasmin@gmail.com
authors.forename: J
authors.initials: J
authors.lastname: Naderi
authors.forename: A W
authors.initials: AW
authors.lastname: Lohse
authors.forename: P R
authors.initials: PR
authors.lastname: Galle
authors.forename: C
authors.initials: C
authors.lastname: Schramm
mesh_terms: D003937:Diagnosis, Differential; D004932:Esophageal and Gastric Varices / Q000175:diagnosis* / Q000209:etiology*; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000175:diagnosis* / Q000209:etiology*; D006801:Humans; D008875:Middle Aged; D055728:Primary Myelofibrosis / Q000150:complications* / Q000175:diagnosis*; D035583:Rare Diseases / Q000150:complications / Q000175:diagnosis