Background: Cameron lesions refer to linear ulcers or erosions found on the crests of mucosal folds near the diaphragmatic impression in individuals with significant hiatal hernias. Bleeding from this lesion can cause significant iron deficiency anemia (IDA). Here, I will discuss a case report of an elderly woman who presented with syncope and later was found to have IDA due to Cameron’s lesion associated with large hiatal hernia. Case Presentation: An 86 years old, Caucasian female with the history of HTN, meningioma, CVA, seizure presented to the ER with sudden loss of consciousness. During extensive diagnostic workup at ER, she was found alert, oriented to time and place with normal physical and systemic examination. Her laboratory report showed a Hb level of 10.8g/dL with a hematocrit count of 30.1%. CT scan of head without contrast was normal. Chest X-ray showed no acute abnormality except the presence of a large hiatal hernia. As she has a history of seizure disorder and her anti-epileptic medication was at subtherapeutic range (Dilantin 4.5), a neurologic consultation was requested. Therefore, she underwent an EEG, and it showed normal findings. Unfortunately, she became weak over the following day and her blood report showed a significant drop in Hb% (Hb 7.3g/dL). Hence, she was scheduled for an urgent upper GI endoscopy. EGD report showed normal hypopharyngeal apparatus with normal esophagus though there was some tortuosity in distal aspect. Partially intrathoracic stomach (35cm-46cm) was noted with retroflexed view of fundus and cardia. A Cameron’s lesion was found along the mucosal folds of gastric fundus. No active bleeding was found. She was diagnosed with hiatal hernia (11cm) with Cameron’s lesion. The patient was discharged with PPI, oral iron tablet, with her regular medications. On her follow up appointments, she showed excellent response to PPI and her Hb% improved with the treatment. Discussion: Cameron lesions may go unnoticed and might be less frequently reported due to the need for a keen sense of suspicion for diagnosis, familiarity with endoscopic visuals, and a thorough examination of the hiatus hernia (HH). Cameron lesions have been reported in up to 5% of patients with HH and up to 13.7% of patients with a large HH (>5cm). This 86 years old lady had a large silent hiatal hernia without any gastric reflux symptoms that ultimately resulted in the development of Cameron’s lesion and subsequent bleeding of the lesion led to the development of IDA.