Pseudomelanosis duodeni associated with chronic renal failure

Abstract

Pseudomelanosis duodeni (PD) is a rare dark speckled appearance of the duodenum associated with gastrointestinal bleeding, hypertension, chronic heart failure, chronic renal failure and consumption of different drugs. We report four cases of PD associated with chronic renal failure admitted to the gastroenterology outpatient unit due to epigastric pain, nausea, melena and progressive reduction of hemoglobin index. Gastroduodenal endoscopy revealed erosions in the esophagus and stomach, with no active bleeding at the moment. In addition, the duodenal mucosa presented marked signs of melanosis; later confirmed by histopathological study. Even though PD is usually regarded as a benign condition, its pathogenesis and clinical significance is yet to be defined.

Pseudomelanosis duodeni in a postrenal transplant patient

“…It has been suggested that melanosis could result from iron deposition in the duodenal mucosa secondary to intramucosal haemorrhage or impairment of luminal iron transport after oral iron supplementation 1 6. This theory is supported by electron microscopy that shows ferrous sulfide in the pigment 7.…”

“…It appears to be more common in women in the sixth to seventh decades of life and has distinctive endoscopic, histopathological and electron microscopic features 1. First described in 1976, it was initially thought to be a form of stored iron 2 .…”

“…First described in 1976, it was initially thought to be a form of stored iron 2 . Pseudomelanosis duodeni has also been described in patients with hypertension, chronic renal failure, chronic heart failure and diabetes mellitus 1 3–5…”

“…It has also been speculated that the pigment may be a combination of melanin-like substances, haemosiderin, lipomelanin and lipofuscin 1 6. Other reports have noted an association between pseudomelanosis duodeni and certain drugs, including propranolol, hydralazine, hydrochlorothiazide and furosemide 1 3 4…”

Pseudomelanosis Duodeni in Post Renal Transplant Patient

“…It appears to be more common in women in the sixth to seventh decades of life and has distinctive endoscopic, histopathological and electron microscopic features. 1 First described in 1976, it was initially thought to be a form of stored iron. 2 Pseudomelanosis duodeni has also been described in patients with hypertension, chronic renal failure, chronic heart failure and diabetes mellitus.…”