A rare cause of hematemesis

An 82-year-old gentleman, who was a nursing home resident, presented with 2 days history of increasing confusion, chest pain and coffee ground vomiting. PMH includes diabetes mellitus type II, ischemic heart disease, hypertension and dementia. He had no history of fever, abdominal pain, altered bowel habits, weight loss or use of non-steroidal anti-inflammatory drugs. On admission his vital signs were stable. Laboratory markers were unremarkable with Hb% of 14g/dl. Normal CXR, ECG and CT Head. His ABG’s show PH: 7.23, BE: -11, Lactate: 3.1.