Gastric siderosis: an endoscopic diagnosis challenge

A 71-year-old man presented for a routine physical examination with multiple comorbidities, including severe panvascular disease and valvulopathy, requiring anticoagulation therapy. He had a history of chronic hemolytic anemia and had been taking oral ferrous sulfate for two years. Upper gastrointestinal endoscopy (UGE) was performed, as part of the study of the persist anemia, revealing an extensive nodular area with multiple brownish deposits and spontaneous hemorrhage. Biopsy showed mild inflammation in the lamina propria and ferric pigment confirmed by positive Perl's iron stain, suggesting drug-induced injury. After diagnosis of GS, iron supplements were discontinued and a UGE nine months later showed no remaining lesions.