9th June 2025

A 17-year-old student with depression presents to the Emergency Department profoundly shocked.

A 17-year-old student with depression presents to the Emergency Department profoundly shocked. She has been having dark vomit, with a coffee ground type consistency for the past hour. The team activates the major haemorrhage protocol and begins resuscitation with blood products. They notice a mucocutaneous pigmentation on her lips which doesn’t rub away when her mouth is cleaned from the vomit. What is the most likely diagnosis?

Select the SINGLE most appropriate option from the list below. Select ONE option only.