Supplementary Material for: MALtoma discovered on an hemorrhagic shock associated with gastric Dieulafoy's lesion: a case-report

Introduction
Dieulafoy’s lesion is a rare but severe cause of digestive bleeding and can rarely present as a hemorrhagic shock which is associated with a severe prognosis(1).
MALToma is a B-cell lymphoma of the malt (mucosa-associated lymphoid tissue). It was reported that MALToma can be revealed by a Dieulafoy’s lesion. Due to the lack of specific endoscopic or clinical characteristics, several endoscopies may be needed to establish the diagnosis of MALToma (2).
Case presentation
A 61-year-old male patient presented to the emergency department with melena and hematemesis. The patient was transferred to the intensive care unit due to hemorrhagic shock. The endoscopic work-up showed large gastric folds which were later confirmed as MALToma in anatomo-pathologic analysis. The echo-endoscopy showed a vessel going through the entire gastric wall whom endoscopically corresponded to a red non-bleeding lesion, confirming the Dieulafoy’s lesion as the origin of the bleeding.
The patient received an endoscopic treatment and was rapidly discharged from the intensive care unit. The evolution was spontaneously favorable, there was no repeat active bleeding.
Conclusion
A gastric MALToma was discovered thanks to a hemorrhagic shock on a Dieulafoy’s lesion which has, not yet been described in the literature.