LAUSR

A 46-year-old man with non-replicative chronic hepatitis B infection and poorly controlled diabetes mellitus (glycosylated hemoglobin (HbA1c), 14.2%) with microalbuminuria, hy-pertension, and dyslipidemia, was referred for investigation of his chronic dyspepsia. Upper gastrointestinal endoscopy performed at another center showed a large excavating ulcer at the incisura (measuring 4 cm) with a firm necrotic base. Biopsies from the margin of the ulcer were negative for malignancy but positive for chronic gastritis, intestinal metaplasia, and Helicobacter pylori . It also showed Candida spores and possible hyphae elements. Repeat evaluation was recommend-ed. The patient was administered H. pylori eradication therapy with 10 days of omeprazole 20 mg twice daily, amoxicillin 1 g twice daily, and clarithromycin 500 mg twice daily followed by maintenance omeprazole (20 mg twice daily). Due to the concern for underlying malignancy, a computed tomography (CT) scan was performed and showed a thickened lesser curve (thickest, 2.5 cm) with peri-gastric, celiac, and retroperitoneal