Pseudomelanosis duodeni in a female adult with chronic renal failure

Pseudomelanosis duodeni is a rare endoscopic finding that manifests as dark speckled spots in the duodenum. It is considered a benign condition and is associated with certain diseases and the use of certain medications. This study reports a case of a 74-yearold woman, with end-stage renal disease under maintenance hemodialysis, hypertension under regular medical control, iron deficiency anemia under oral iron supplement, and progressive anemia with suspicious occult gastrointestinal bleeding. Upper gastrointestinal endoscopy revealed multiple tiny brownish-black pigmentation throughout the proximal second portion of the duodenum. The histopathological examination showed pigment-laden macrophages with positive iron stain and negative melanin stain in the lamina propria of the mucosal villi. Copyright (C)2014, The Gastroenterological Society of Taiwan and The Digestive Endoscopy Society of Taiwan. Published by Elsevier Taiwan LLC. Open access under CC BY-NC-ND license.