INTRODUCTION: Acute Myelogenous Leukemia (AML) is a heterogenous group of cancers of blood cells associated with many dysfunctions due to monoclonal expansion of blood marrow. AML typically presents with symptoms of pancytopenia, including general fatigue, weakness, infections, ecchymoses, epistaxis, or menorrhagia. Overt GI bleeding is not a common initial presentation for AML. CASE DESCRIPTION/METHODS: Our patient was an 85-year-old female with a past medical history of gastrointestinal bleed while taking DOAC for pulmonary embolism, gastroesophageal reflux disease, hypertension, and uterine adenoma with subsequent hysterectomy and bilateral oophorectomy. She presented with complaint of “jet black” stools for 12 hours and accompanying weakness. She had no other alarm symptoms including pallor, bruising, neurological complaints, weight loss, hematochezia, or night sweats. She was known to have a hiatal hernia on previous EGDs and a bleeding distal rectal mucosal lesion concerning for a Dieulafoy lesion, both of which were two years prior to admission. Her initial labs were significant for hemoglobin 8.4, platelets 24, INR 1.0, and white blood cell count 5.1 with normal differential. Upper GI bleed was suspected, despite her previous lower GI bleeding, and the first upper endoscopy was performed; this revealed a possible Dieulafoy lesion that was hemoclipped. Her anemia and melena continued to worsen and Hematology performed a bone marrow biopsy. In the intervening time, two more upper endoscopies were performed yielding no further evidence of bleeding. Given her continued symptoms, colonoscopy was performed showing blood in the terminal ileum and right colon with no obvious lesion; there was, however, discrete mucosal bleeding sites in the rectum with no lesions noted after extensive cleaning. Multiple hemoclips were placed in the rectum but,ultimately, none of the endoscopic interventions proved durative. Shortly after colonoscopy, bone marrow biopsy revealed AML. DISCUSSION: Our case highlights a unique presentation of AML, where gastrointestinal bleeding is the first major presenting symptom. Bruising, epistaxis, and vaginal bleeding are the most typical types of bleeding in AML, none were found in this patient. AML is due to dysfunctions due to monoclonal expansion blood marrow that can lead to preferentially nonfunctional blood lines. This patient had significant thrombocytopenia with cells that were dysfunctional, leading to diffuse gastrointestinal hemorrhage without the presence of bleeding lesions.