Christine A. Catinis, BS, MS1, Daniel Raines, MD, FACG2 1LSU School of Medicine, New Orleans, LA; 2Louisiana State University New Orleans, New Orleans, LA
Introduction: Pseudomelanosis is a rare, benign endoscopic finding characterized by hyperpigmentation of the mucosa secondary to accumulation of iron-sulfide-containing macrophages in the lamina propria1,2. Few cases have been reported, particularly of esophageal and gastric pseudomelanosis, leaving much to be discovered regarding this presentation. Here, we describe a case of pseudomelanosis involving the gastroesophageal junction.
Case Description/Methods: An 80 year old female with a history of chronic kidney disease, hypertension, coronary artery disease, and systolic heart failure presented with persistent left-sided abdominal pain for two days. Her home medications include amiodarone, bumetanide, hydralazine, and metoprolol succinate. Upper endoscopy revealed notable focal hyperpigmentation of the gastroesophageal junction, gastric antrum, and duodenal bulb. H&E showed prominent dark brown-black pigment within macrophages that stained focally positive for iron. This incidental finding, while unrelated to her initial presentation, was consistent with pseudomelanosis and showed no indication for further management.
Discussion: Although its precise etiology remains unknown, pseudomelanosis has been reported in association with chronic kidney disease, upper gastrointestinal bleeding, hypertension, diabetes mellitus, coronary artery disease, iron-deficiency anemia, and certain medications such as hydralazine, furosemide, and oral iron supplementation2-5. In addition, there is an apparent female predominance, particularly in the 6th and 7th decades of life1,5. Our patient possessed a number of these risk factors, which along with the H&E findings, further supports our diagnosis of pseudomelanosis of the gastroesophageal junction, gastric antrum, and duodenal bulb. Despite its impressive appearance, it is considered a benign incidental finding and its prognostic and clinical significance remains unknown.
1. Zakaria A et al., Pseudomelanosis intestini "from pylorus to jejunum:" A rare endoscopic finding in a patient with GI bleeding. 2018; 1120-1122. 2. Samiullah S et al., Peppered and rare - Gastric and Duodenal Pseudomelanosis: A case series, 2017; 757-760. 3. Yamase H, Norris M, Gillies C. Pseudomelanosis duodeni: a clinicopathologic entity. Gastrointest Endosc. 1985; 83-86. 4. Treeprasertsuk S et al., Pseudomelanosis duodeni: association with hypertension and chronic renal failure: case report, 2000. 5. Brown et al., Pseudomelanosis of Barrett's Esophagus, the Gastric Antrum, Duodenum, and Jejunum, 2006.
Figure: EGD images reveal focal hyperpigmentation of the gastroesophageal junction (A), duodenal bulb (B), and the distal duodenum (C). Images (D), (E), and (F) show pigment-laden macrophages in the lamina propria of the gastroesophageal junction that stained focally positive for iron.
Christine Catinis indicated no relevant financial relationships.
Daniel Raines indicated no relevant financial relationships.
Christine A. Catinis, BS, MS1, Daniel Raines, MD, FACG2. P1510 - Rare Finding of Pseudomelanosis at the Gastroesophageal Junction: A Case Report, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.