Gastric and Duodenal Pseudomelanosis: An Extended Unusual Finding in a Patient with End Stage Kidney Disease

Abstract

Gastric and duodenal pseudomelanosis is a rare endoscopic mucosal finding, characterized by the accumulation of iron in macrophages of the lamina propria of the stomach and duodenum. The clinical significance and long term sequelae have not been clarified yet. However, this benign condition is associated with a variety of clinical conditions, such as essential hypertension, chronic renal failure, diabetes mellitus, long term intake of iron supplements, and furosemide. Duodenal pseudomelanosis appears to be more common than gastric pseudomelanosis given the fact that a few cases of gastric pseudomelanosis have been reported in the literature so far. We report a case of 88-year-old lady with ESRD who is maintained on hemodialysis and presented with abdominal pain. An upper GI endoscopy showed discoloration of the antrum of the stomach and most portion of her duodenum. Histopathology report confirmed the presence of iron laden macrophages in the lamina propria of both stomach and duodenum.

A Rare Case of Duodenal Pseudomelanosis

“…Duodenal biopsy samples stained with routine hematoxylin and eosin (B) showed aggregates of pigment-laden macrophages in the lamina propria of the apical portion of the villi, which tested intensely positive with Perl's stain for iron; enterocytes demonstrated a faint positivity for Perl's Prussian blue underneath the microvilli (B, inset). These findings were consistent for duodenal pseudomelanosis, a benign condition which harbors no known clinical sequelae[1][2][3][4][5][6][7][8][9][10][11][12][13].…”

Rare Finding of Concomitant Pseudomelanosis of Stomach and Duodenum

“…In addition to these comorbidities associated with melanosis, the patient was prescribed furosemide and iron supplements long-term. An upper GI endoscopy revealed gastric and duodenal discoloration, and a biopsy confirmed the diagnosis of melanosis gastri and duodeni ( 5 ).…”

“…It is typically seen in older women and has been associated with several clinical conditions, some of which include: hypertension, hemochromatosis, diabetes, chronic renal disease, and gastrointestinal bleeding. Gastric and duodenal melanosis has also been seen in connection with medications containing ferrous sulfate as well as with antihypertensive medications, like furosemide, hydrochlorothiazide, propranolol, and hydralazine ( 5 ).…”

Pseudomelanosis duodeni: A case report. Literature review

“…El pigmento descrito se debe esencialmente al depósito de hierro dentro del citoplasma de los macrófagos, que se encuentran en la lámina propia situados alrededor de los vértices de las vellosidades duodenales, detectado por histoquímica y microscopía electrónica, se debería a la auto-oxidación de sulfuro de hierro a óxido de hierro dentro de los macrófagos lo que produce la coloración característica [3][4][5] . La patogenia no es clara, puede estar relacionada con el depósito de hierro secundario a hemorragia intramucosa o a alteración del transporte después del suplemento de hierro sulfato oral, difiere de la "melanosis" coli en la naturaleza del pigmento descrito por lipofuscina y no melanina, la melanina no contiene hierro y los melanocitos no están presentes en la mucosa gastrointestinal, la pigmentación marrón negruzca de la mucosa se debe a la administración de laxantes antraquinónicos derivados de plantas como la cáscara sagrada, el sen, la frángula, el aloe autoadministrados en casos de estreñimiento crónico 6,7 . Esta alteración se ha observado entre la sexta y séptima década de la vida, la mayoría son mujeres, con antecedentes de hipertensión arterial, insuficiencia cardíaca crónica, insuficiencia renal crónica, hemorragia gastrointestinal, usuarios de propanolol, hidralazina e hidroclorotiazida, la terapia con hierro oral tiene la más fuerte asociación [8][9][10] .…”