Duodenal pseudomelanosis (pseudomelanosis duodeni): a rare endoscopic finding
AbstractDuodenal pseudomelanosis (or pseudomelanosis duodeni) is a rare benign
condition characterized by black-brown speckled pigmentation of the duodenal
mucosa. Collections of pigment−laden macrophages are found in the tips of
duodenal villi. The pigment is thought to be mostly composed of ferrous sulfide.
Histochemichal stains for iron (Perl’s prussian blue) or melanin (Masson-
Fontana) may be positive, but are usually negative or unpredictable. Duodenal
pseudomelanosis occurs predominantly in middle-aged to old adults and
more commonly in females. It is associated with chronic renal failure, arterial
hypertension, diabetes mellitus and gastrointestinal bleeding. Medications such
as ferrous sulfate, hydralazine, propranolol, hydrochlorothiazide and furosemide
are thought to play a role as well. We report a case of a 86-year-old female
who presented with a history of watery diarrhea and melena. The patient had a
history of high blood pressure and ischemic stroke episodes. She was on multiple
medication including hidralazine, captopril, hydrochlorthiazide and aspirin. She was
dehydrated, her blood pressure was 96 × 60 mmHg and neurologic examination
showed complete left hemiplegia with central VII nerve palsy. Laboratory tests
showed normal serum electrolytes and renal function. Hemoglobin level was
10.7 g%. An upper endoscopy showed multiple diminutive black spots throughout
the distal duodenal bulb and second portion. Histology showed multiple foci of
a brown-black granular pigment inside macrophages within the tips of the villi
(pseudomelanosis). Stains for iron and melanin were negative. She was treated
with omeprazol, parenteral fluid replacement with saline and partial fasting. After
complete recovery she was discharged for ambulatory follow up.
Copyright (c) 2017 Autopsy and Case Reports
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
Copyright and publishing license
Authors retain copyright granting the journal right of first publication with the work simultaneously licensed under the Creative Commons Attribution Non-Commercial License.
Autopsy and Case Reports accepted articles are published under the Creative Commons Attribution Non-Commercial License. Under this License, the authors agree to have the CC-BY-NC license applied to their work, which retains the author's ownership of the copyright for their article and permits unrestricted non-commercial use, distribution, and reproduction in any medium provided the original authors and source are properly cited. This facilitates freedom in re-use and also ensures that the journal's content can be mined without barriers for the needs of research.