Pseudomelanosis of the stomach and duodenum: an uncommon endoscopic finding

Abstract

A woman (70-years) with a history of iron deficiency anemia and chronic kidney disease presented with two weeks of abdominal pain. Upper endoscopy demonstrated the gastric and duodenal mucosa was black and speckled consistent with diagnosis of pseudomelanosis. Biopsies showed pigment-laden macrophages in the lamina propria, which stained positive for iron and Masson-Fontana trichrome stain consistent with a “melanin-like” pigment. Although an uncommon endoscopic finding, this pigment has been associated with the use of certain medications, antihypertensives and iron supplements, and systemic illnesses, including hypertension, chronic kidney disease, gastric hemorrhage, and diabetes mellitus.

Rare Finding of Concomitant Pseudomelanosis of Stomach and Duodenum

“…An upper endoscopy identified black, speckled gastric and duodenal mucosa, and biopsy specimens stained positive for the Fontana-Masson trichrome stain, officially diagnosing the patient with melanosis. Both of the patients in these two case reports were elderly women with some of the same comorbidities ( 7 ).…”

Black speckled duodenal mucosa

“…Unlike pseudomelanosis coli, pseudomelanosis duodeni does not have a known association with anthraquinone-containing laxatives but is seen in conjunction with sulfur-containing antihypertensive medications such as thiazide diuretics and furosemide, beta-blockers, hydralazine, and oral iron supplements. 1 Pseudomelanosis duodeni is present on histology even prior to its appearance on endoscopy, and a hence a temporal relationship with the above-mentioned conditions has not been established thus far.…”

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

“…Pseudomelanosis duodeni has been reported on multiple occasions, but to the best of our knowledge, only 7 cases of gastric pseudomelanosis have been previously reported in the literature [ 2 ]. Pseudomelanosis is characterized by the detection of speckled dark pigmentations on endoscopy [ 3 ]. There is no specific etiology, but a number of factors has been linked to pseudomelanosis including diabetes mellitus, hypertension, chronic kidney disease, hemochromatosis, gastrointestinal bleeding, and the use of certain medications [ 2 ].…”