Pseudomelanosis duodeni: a propósito de un caso - revisión de literatura / Pseudomelanosis duodeni: a case report - literature review

Pseudomelanosis duodeni is a very rare appearance of the duodenal mucosa, characterized by the presence of a dark pigment (iron oxide) seen in the surface of the villi, evident by endoscopy. It can be associated with pathologies such as arterial hypertension, chronic heart failure, chronic kidney failure, gastrointestinal bleeding, and consumption of different drugs. We describe the case of a 68-year-old male patient, with chronic renal insufficiency, hemodialysis and intravenous iron treatment.

La Pseudomelanosis duodeni es una entidad muy poco frecuente de la mucosa duodenal que se caracteriza por la presencia de un pigmento oscuro de las vellosidades (oxido de hierro) que es evidente mediante endoscopía y puede estar asociado a patologías como hipertensión arterial, insuficiencia cardíaca crónica, insuficiencia renal crónica, hemorragia gastrointestinal y consumo de diferentes fármacos. Describimos el caso de un paciente masculino de 68 años, con antecedentes de insuficiencia renal crónica, en hemodiálisis y uso de hierro intravenoso.

Small Bowel Pseudomelanosis Associated with Oral Iron Therapy

An accumulation of pigment deposits on mucosa, called melanosis or pseudomelanosis, of the small bowel is observed infrequently during endoscopic examination. We describe 6 cases of small bowel pseudomelanosis; the possible etiology of which was chronic iron intake. We observed numerous brown spots in duodenum, jejunum, and terminal ileum during upper and lower endoscopy. Interestingly, all patients have been taking oral iron for several years. Histology showed pigment depositions within macrophages of the lamina propria and a positive Prussian blue stain indicating hemosiderin deposition. Herein, we demonstrate that long term iron therapy may result in pseudomelanosis of small bowel, such as duodenum, jejunum, and ileum.

A Case of Pseudomelanosis Duodeni / 대한소화기내시경학회지

Pseudomelanosis duodeni is a rare benign condition in which dark pigments accumulate in macrophages located in the lamina propria of the duodenal mucosa. Most reported cases had hypertension with or without chronic renal failure, and were taking antihypertensive agents and iron supplements. Therefore, it has been assumed that pseudomelanosis duodeni is associated with these medications. Our case was a 77 year-old female patient diagnosed as having hypertension, congestive heart failure, iron deficiency anemia, and depression, who had been treated with antihypertensive agents and iron supplement. Upper gastrointestinal endoscopy revealed many tiny discrete dark macules scattered throughout the first and second portions of the duodenum. Endoscopic mucosal biopsy disclosed macrophages with Prussian blue and Fontana-Masson stain positive pigments, which suggested that the nature of pigment was iron sulfide.