A 56-years-old women admitted in the ER for nausea, vomiting, epigastric pain and fever. The patient had medical history of acromegaly and chronic kidney disease of undetermined etiology. Elevated C-reactive protein and renal dysfunction. Abdominal-CT revealed duodenal parietal thickening and pancreatic head edema. On esophagogastroduodenoscopy (EGD) duodenal mucosa had adiffusely nodular aspect withulcerated areas.