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A Rare Finding of Gastric Pseudomelanosis in Chronic Kidney Disease: A Case Report
Mohamed Ibrahim1, Michael Herman2
1Osteopathic Medicine, Lake Erie College of Osteopathic Medicine, Bradenton, USA.
Abstract:
Pseudomelanosis is a black-brown discoloration of the loose connective tissue layer of the intestinal mucosa, also known as the lamina propria. Although it is a benign condition and poses no real threat to the patient, it has been known to be associated with certain medication use in the colon, like anthraquinone laxatives, as well as various chronic illnesses in the duodenum and stomach, like iron deficiency anemia, end-stage kidney disease, hypertension, and diabetes mellitus. Only a handful of cases of gastric pseudomelanosis have been reported in the literature, often presenting to the physician as an elderly female with dark, tarry stools from excessive iron use. In this unusual case, a 75-year-old male came to the emergency room due to a concern about blackish stools in the toilet. After reviewing his past medical history, it was found that he takes iron tablets for anemia secondary to end-stage renal disease. While enteric iron was most likely the cause of the melena, an esophagogastroduodenoscopy (EGD) study was performed to rule out any proximal causes of gastrointestinal bleeding. Following the upper endoscopy, gastric pseudomelanosis was established.
Insights
Gastric pseudomelanosis, a black discoloration of the stomach lining, can be caused by iron supplements, especially in patients with end-stage renal disease. This benign condition was confirmed via esophagogastroduodenoscopy in an elderly male patient.
Area of Science:
- Gastroenterology
- Pathology
Background:
- Pseudomelanosis is a benign black-brown discoloration of the intestinal lamina propria.
- It is associated with certain medications (e.g., anthraquinone laxatives) and chronic conditions (e.g., end-stage kidney disease, diabetes mellitus).
- Gastric pseudomelanosis is rare, with few reported cases.
Observation:
- A 75-year-old male presented with concerns about blackish stools.
- His medical history revealed anemia secondary to end-stage renal disease, for which he was taking iron tablets.
- Enteric iron was suspected as the cause of melena.
Findings:
- An esophagogastroduodenoscopy (EGD) was performed to exclude proximal gastrointestinal bleeding.
- The EGD confirmed the presence of gastric pseudomelanosis.
- This case highlights an unusual presentation of gastric pseudomelanosis in an elderly male patient.
Implications:
- This case underscores the importance of considering medication side effects, particularly iron supplementation, in the differential diagnosis of dark stools.
- It emphasizes the utility of upper endoscopy in evaluating gastrointestinal symptoms, even when a likely cause is identified.
- Further research may elucidate the precise mechanisms and prevalence of gastric pseudomelanosis in specific patient populations.
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