Rare Finding of Concomitant Pseudomelanosis of Stomach and Duodenum

Abstract

Melanosis of the stomach and duodenum is a rare entity and a striking finding diagnosed by upper gastrointestinal endoscopy. Here, we describe the case of an 83-year-old female, with a complicated medical history, who was referred to gastroenterologist to assess bleeding risk. From the endoscopy, it was determined that she had both melanosis gastri and duodeni. Although both are rare, gastric melanosis appears to be even more unusual than duodenal melanosis, with only a few reported cases documented in the literature thus far.

A Rare Case of Duodenal Melanosis: Case Report

“…Medications that were common among these patients were iron supplements and different classes of anti-hypertensives such as hydrochlorothiazide, atenolol, lisinopril/quinapril and irbesartan [9]. Other case reports have described PM as an incidental finding in patients presenting with gastrointestinal bleeding, similar to our patient [13,14]. The mechanism by which these diseases and medications contribute to PM is not known.…”

A Rare Finding of Gastric Pseudomelanosis in Chronic Kidney Disease: A Case Report

“…Gastric and duodenal pseudomelanosis are very rare and benign findings that are most often found incidentally on endoscopy following a complaint of abdominal pain, hematemesis, hematochezia, or melena [ 5 ]. The common theme amongst the few case reports that have been documented was the presence of iron in the tips of the lamina propria within the greater curvature of the stomach, or duodenal villi [ 6 ].…”

Pseudomelanosis duodeni: A case report. Literature review

“…Los primeros 6 casos fueron descritos en el año 1976, el término melanosis da una falsa idea de que el pigmento es producido por melanocitos 1,2 . 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 .…”