Virginia Commonwealth University Health System Richmond, VA, United States
Irma Hashmi, DO1, Marcus Healey, DO2 1Virginia Commonwealth University Health System, Richmond, VA; 2Virginia Commonwealth University, Richmond, VA
Introduction: Melanosis coli is a well-documented finding of hyperpigmentation of the colon seen in patients who take laxatives chronically. However, another entity, with a similar tigroid appearance, also exists in the upper gastrointestinal tract. Seen only in a few case reports in the literature, we present the case of an extremely rare but interesting endoscopic finding: pseudomelanosis duodeni (PD).
Case Description/Methods: Patient is a 64-year-old male with past medical history of decompensated HCV cirrhosis, status post liver transplant in 2011, with concern for graft cirrhosis, hypertension, and chronic kidney disease, who presented for esophageal variceal screening. The patient had no complaints on evaluation. Physical exam was unremarkable and without stigmata of cirrhosis; laboratory values revealed normal liver function. Creatinine, though, was elevated at 2.8 mg/dL, with estimated GFR 30. Endoscopy showed unremarkable esophagus and stomach; however, duodenum showed speckled brown stripes, characteristic of pseudomelanosis duodeni (Figure 1). Findings were not biopsied due to their characteristic appearance. The patient did not require further follow up for the benign condition and was discharged home from the endoscopy suite.
Discussion: Characterized by brown to black speckled spots on endoscopy, psuedomelanosis duodeni is, reassuringly, a more visually impressive than concerning finding. Unlike melanosis coli which reveals lipofuscin in macrophages on histology, PD is due to iron sulfide, hemosiderin lipomelanin and ceroid pigment deposition in macrophages. It also differs from melanosis coli as it is not related to laxative use; rather, it is associated with chronic kidney disease, as seen with our patient. It is also seen in patients with hypertension, diabetes and coronary artery disease and medications such as furosemide, hydralazine and thiazide. PD can be seen in elderly patients and has a female predominance. As it is considered a benign condition, treatment of pseudomelanosis duodeni is not required. The patient may simple be assured of this incidental and unique finding.
Figure: Figure 1
Disclosures: Irma Hashmi indicated no relevant financial relationships. Marcus Healey indicated no relevant financial relationships.
Irma Hashmi, DO1, Marcus Healey, DO2. P1987 - A Different Type of Tiger Stripes: A Case of Pseudomelanosis Duodeni, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.