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Pseudomelanosis duodeni associated with chronic renal failure
Marcia Henriques de Magalhães Costa, Maria da Gloria Fernandes Pegado, Cleber Vargas, Maria Elizabeth C Castro, Cyrla Zaltman, Gastroenterology Section, Department of Internal Medicine, Clementino Fraga Filho University Hospital, Universidade Federal do Rio de Janeiro, Rio de Janeiro 21941-913, Brazil
Kalil Madi, Department of Pathology, Clementino Fraga Filho University Hospital, Universidade Federal do Rio de Janeiro, Rio de Janeiro 21941-913, Brazil
Tiago Nunes, Hospital Clínic i Provincial/IDIBAPS, Barcelona 08036, Spain
Author contributions: Costa MHM and Zaltman C contributed equally to this work; Madi K contributed histopathological analysis; Pegado MGF, Vargas C and Castro MEC performed all endoscopic evaluations and reviewed the current literature on the subject; Costa MHM, Zaltman C and Nunes T wrote the paper.
Correspondence to: Cyrla Zaltman, MD, PhD, Associate Professor of Gastroenteology, Gastroenterology Section, Department of Internal Medicine, Clementino Fraga Filho University Hospital, UFRJ, Rio de Janeiro 21941-913, Brazil. email@example.com
Telephone: +55-21-88773787 Fax: +55-21-22421637
Received: April 2, 2011
Revised: September 30, 2011
Accepted: February 27, 2012
Published online: March 28, 2012
Pseudomelanosis duodeni (PD) is a rare dark speckled appearance of the duodenum associated with gastrointestinal bleeding, hypertension, chronic heart failure, chronic renal failure and consumption of different drugs. We report four cases of PD associated with chronic renal failure admitted to the gastroenterology outpatient unit due to epigastric pain, nausea, melena and progressive reduction of hemoglobin index. Gastroduodenal endoscopy revealed erosions in the esophagus and stomach, with no active bleeding at the moment. In addition, the duodenal mucosa presented marked signs of melanosis; later confirmed by histopathological study. Even though PD is usually regarded as a benign condition, its pathogenesis and clinical significance is yet to be defined.