Case of speckled black pigmentation of duodenum in 83-year-old.
An 83-year-old male patient presented with the complaint of an oesophageal obstruction that had occurred while eating pork. The patient was diagnosed with pseudomelanosis duodeni, speckled black pigmentation of the duodenum.
The patient’s history revealed that he had intermittent difficulty swallowing for several months. Similarly, he had stage 4 chronic kidney disease, type II diabetes mellitus and hypertension. The patient was on antihypertensive medications, including metoprolol, lercanidipine, irbesartan and hydralazine. However, he was not on any iron supplementation.
To remove the impacted food, an urgen esophagogastroduodenoscopy was done. During the endoscopy it was seen that the duodenal mucosa has a speckled black pigmentation that extended along the villi. The duodenum was biopsied. Histopathological analysis stained with hematoxylin and eosin showed macrophages laden with black pigment in the lamina propria.
The findings were consistent with the diagnosis of pseudomelanosis duodeni.
Pseudomelanosis duodeni or speckled black pigmentation of the duodenum is associated with certain medications, for example, iron supplements and cardiovascular medications, chronic renal failure, chronic heart failure, hypertension and gastrointestinal bleeding. The condition is regarded as benign and no specific treatment is indicated. In this case the patient had chronic kidney disease and was prescribed cardiovascular medications.
The patient had an uneventful recovery after the endoscopy and was referred for outpatient evaluation of dysphagia.
Pseudomelanosis Duodeni https://www.nejm.org/doi/full/10.1056/NEJMicm2001352