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Pseudomelanosis duodeni in a postrenal transplant patient
Theresa Schuerle1, Elie Aoun, Kofi Clarke
1West Penn Allegheny Health System, Pittsburgh, Pennsylvania, USA.
Abstract:
Pseudomelanosis duodeni is a rare entity characterised by dark pigmented intracellular granules seen within macrophages that lie within the lamina propria of the duodenal villi. There is no known treatment, and the clinical significance and long-term sequelae of this entity are unclear. We present a case of pseudomelanosis duodeni in a 54-year-old woman who presented with a 1-month history of nausea, vomiting and non-bloody diarrhoea. The medical history was significant for diabetes mellitus type 2, end-stage renal disease status postkidney transplant, hypertension, anaemia of chronic disease and hypothyroidism. A gastroduodenal endoscopy revealed pigmented dark lesions in the duodenal mucosa. Biopsies from the second part of the duodenum and duodenal bulb showed pigmented macrophages in the lamina propria. The findings were consistent with duodenal melanosis. In spite of renal transplant with normalisation of renal function, the duodenal melanosis persists, which raises questions on the role of renal impairment in this entity.
Insights
Pseudomelanosis duodeni, a rare condition causing dark pigment in the duodenum, was observed in a patient with multiple comorbidities. The pigment persisted despite a successful kidney transplant, questioning the role of renal impairment.
Area of Science:
- Gastroenterology
- Pathology
- Nephrology
Background:
- Pseudomelanosis duodeni is a rare duodenal finding characterized by pigmented macrophages.
- Its clinical significance and long-term sequelae remain unclear.
- No established treatment exists for this condition.
Observation:
- A 54-year-old woman with diabetes mellitus type 2, end-stage renal disease, hypertension, anemia, and hypothyroidism presented with nausea, vomiting, and diarrhea.
- Endoscopy revealed dark, pigmented lesions in the duodenal mucosa.
- Biopsies confirmed pigmented macrophages in the duodenal lamina propria, consistent with pseudomelanosis duodeni.
Findings:
- The patient underwent a kidney transplant, achieving normalized renal function.
- Despite successful renal transplantation, the duodenal melanosis persisted.
- This persistence challenges the direct causative role of renal impairment in pseudomelanosis duodeni.
Implications:
- The case highlights the persistent nature of pseudomelanosis duodeni even after resolution of renal dysfunction.
- Further research is needed to elucidate the etiology and clinical impact of this rare entity.
- Understanding the factors contributing to pseudomelanosis duodeni may guide future management strategies.
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