Icahn School of Medicine at Mount Sinai (Elmhurst Hospital Center) Elmhurst, NY, United States
Jonathan Vincent M. Reyes, MD, MHA1, Tasur Seen, MD1, Ahmed Al-Khazraji, MD2, Vennis Lourdusamy, MD1, Moiz Ahmed, MD1, Bhanu Singh, MD1, Aaron Walfish, MD1 1Icahn School of Medicine at Mount Sinai (Elmhurst Hospital Center), Elmhurst, NY; 2Elmhurst Hospital Center, Elmhurst, NY
Introduction: Gastric mucosal calcinosis (GMC) is a rare histological finding characterized by calcium deposition in the gastric mucosa. It has been linked to electrolyte abnormalities in the setting of malignancy, chronic renal failure, and hyperparathyroidism. It can lead to long-standing dyspepsia.
Case Description/Methods: A 61-year-old man presented with 2 weeks of sharp epigastric pain. He reported multiple hospitalizations in the past for similar symptoms. His medical history was significant for ESRD secondary to hypertension requiring hemodialysis as well as renal osteodystrophy secondary to hyperparathyroidism resulting in a parathyroidectomy. Labs revealed a hemoglobin of 10.5 mg/dL, an elevated BUN 35 mg/dL, a creatinine of 8 mg/dl and hypercalcemia with a Ca level of 11.5 mg/dl. The evaluation included an esophagogastroduodenoscopy (EGD), a colonoscopy, and a CT angiogram of the abdomen. The CT of the abdomen revealed diffuse atherosclerotic disease with calcium deposition in the soft tissue and vasculature with no evidence of acute pathology. Colonoscopy discovered pan-diverticulosis. The EGD showed evidence of severe gastritis. Pathology of the stomach biopsies demonstrated numerous black calcium deposits within the squamous mucosa and fibrinopurulent exudate significant for gastric mucosal calcinosis.
Discussion: Mucosal calcinosis has a predisposition to gastric, cardiac, lung, and kidney tissue due to their intracellular alkalinity. GMC is categorized into dystrophic, idiopathic, and metastatic. Metastatic calcifications occur in the settings of altered metabolism of serum calcium and phosphorus and can occur as a complication of chronic renal failure. Iatrogenic calcifications are secondary to sucralfate, isotretinoin, or calcium therapy. Dystrophic calcifications occur due to local tissue damage that causes the deposition of calcium salts in fibrotic and inflamed tissue. Patients with GMC can frequently be asymptomatic and the diagnosis is usually made postmortem. Histological findings of GMC include basophilic intraepithelial deposits of calcium within the squamous mucosa which will stain positive on a von Kossa stain. Treatment options for this disease are limited. IV sodium thiosulfate has been described as a potential therapy by competitively binding calcium to form a highly soluble calcium salt. As the prevalence of patients with ESRD increases, clinicians should be mindful of this rare complication and its role as a possible cause for chronic abdominal dyspepsia.
Jonathan Vincent Reyes indicated no relevant financial relationships.
Tasur Seen indicated no relevant financial relationships.
Ahmed Al-Khazraji indicated no relevant financial relationships.
Vennis Lourdusamy indicated no relevant financial relationships.
Moiz Ahmed indicated no relevant financial relationships.
Bhanu Singh indicated no relevant financial relationships.
Aaron Walfish indicated no relevant financial relationships.
Jonathan Vincent M. Reyes, MD, MHA1, Tasur Seen, MD1, Ahmed Al-Khazraji, MD2, Vennis Lourdusamy, MD1, Moiz Ahmed, MD1, Bhanu Singh, MD1, Aaron Walfish, MD1. P2068 - Recurrent Dyspepsia Secondary to Gastric Mucosal Calcinosis GMC, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.