An Incidental Finding of Gastric and Duodenal Pseudomelanosis: A Case Report

Abstract

Pseudomelanosis of the upper gastrointestinal tract is a rare diagnosis of undetermined significance, most commonly affecting the duodenum. Endoscopically, it is characterized by dark spickled pigmentation . Its development has been linked to certain conditions and medications. Involvement of the stomach is extremely rare with very few cases reported in the literature to date. We report an 85-year-old male who is known to have type 2 diabetes mellitus, dyslipidemia, iron deficiency anemia, and chronic kidney disease who underwent an esophagogastroduodenoscopy for evaluation of upper gastrointestinal bleeding and was found to have gastric and duodenal pseudomelanosis confirmed by biopsy. It is an extremely rare benign condition, but metastatic melanoma has to be ruled out, as was done in this case.

Drug-induced mucosal alterations observed during esophagogastroduodenoscopy

“…A black to dark brown pigmentation can be observed in the duodenum, termed duodenal pseudomelanosis (Figure 8 )[ 54 , 82 - 85 ]. This condition is often observed in patients with chronic diseases such as hypertension, chronic kidney failure, and diabetes.…”

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

“…The incidence in the large intestine has been reported between 0.82% and 1.13%, with a staggering 95% of those patients disclosing they take anthraquinone laxatives [ 2 ]. On the contrary, to the best of our knowledge, only eight other reported cases of gastric pseudomelanosis were previously found in the literature [ 3 , 4 ]. There does seem to be a correlation between this condition and other chronic diseases that we see in our patients as well, such as diabetes mellitus, hypertension, iron deficiency anemia, chronic kidney disease, gastrointestinal bleeding, and hemochromatosis [ 3 ].…”

“…On the contrary, to the best of our knowledge, only eight other reported cases of gastric pseudomelanosis were previously found in the literature [ 3 , 4 ]. There does seem to be a correlation between this condition and other chronic diseases that we see in our patients as well, such as diabetes mellitus, hypertension, iron deficiency anemia, chronic kidney disease, gastrointestinal bleeding, and hemochromatosis [ 3 ]. We present the case of a 75-year-old male who arrived at the emergency department from a rehabilitation center after noticing dark, tarry stools in the toilet.…”