Paroxysmal Nocturnal Hemoglobinuria Presenting with Hemorrhagic Esophageal Varices

A 25-year-old male with no medical history presented with three days of melena and hematemesis. He had no prescribed medications but reported occasional intake of over the counter antacids for heartburn. He did not use tobacco or illicit drugs, and drank 5 alcoholic beverages per week. He denied history of easy bruising or bleeding, nor a family history of any hematologic or gastrointestinal disorders. Upon presentation, he was lethargic with vital signs notable for tachycardia to 106 beats per minute and blood pressure 74/50 mmHg.