Lanthanum-Induced Gastrointestinal Histiocytosis

Abstract

A patient with end-stage renal disease (ESRD) on hemodialysis presented with fever, anorexia, and nausea shortly after starting oral lanthanum carbonate for phosphate control. Gastric and duodenal biopsies demonstrated diffuse histiocytosis with intracellular aggregates of basophilic foreign material. Transmission electron microscopy, an underutilized diagnostic test, revealed the nature of the aggregates as heavy metal particles, consistent with lanthanum. Symptoms and histiocytosis improved after discontinuation of lanthanum. Lanthanum may be an underdiagnosed cause of gastrointestinal histiocytosis.

Gastric lanthanosis (lanthanum deposition) in dialysis patients treated with lanthanum carbonate

“…We named this under‐recognized condition “gastric lanthanosis” and defined it as La deposition in the gastric mucosa of dialysis patients treated with LaC. There were several previous studies on gastric lanthanosis, but most of these were case reports from Japan . The present report is the first comprehensive study with a proposed mechanism.…”

“…To date, serious signs and symptoms related to gastric lanthanosis have not been reported. Follow‐up data after stopping administration of LaC was described in three patients . In these reports, La deposition vanished or markedly decreased after 3–8 months.…”

“…However lanthanum (La) deposition in the liver and bone has been reported in animal experiments . Contrary to conventional wisdom, there have been several reports of La deposition in the human gastric mucosa of dialysis patients treated with LaC since 2015 . In 2009, an autopsy report of a case of nephrogenic systemic fibrosis with La deposition in the mesenteric lymph nodes was published, but findings in the stomach were not described .…”

“…2,4 Contrary to conventional wisdom, there have been several reports of La deposition in the human gastric mucosa of dialysis patients treated with LaC since 2015. [5][6][7][8][9][10][11][12] In 2009, an autopsy report of a case of nephrogenic systemic fibrosis with La deposition in the mesenteric lymph nodes was published, but findings in the stomach were not described. 13 This under-reported lesion has not been comprehensively investigated, and the clinical significance and mechanism remains unclear.…”

Long-term observational study in Japanese hemodialysis patients who completed a 3-year clinical study of lanthanum carbonate

“…Thus, the long-term safety of LC treatment, especially in clinical practice, has not been completely established. In recent years, several case reports about La deposition in gastric mucosa have been published [22][23][24][25]. Although Data are given as mean ± standard deviation (n) CI confidence interval V.S.…”