Black pigmentation in duodenum

Here, we present the case of an 87-year-old woman with heart failure, hypertension, and iron deficiency anemia a treatment history amlodipine, olmesartan, carvedilol, hydralazine for 4 years, ferrous sodium citrate 2 years. The patient was referred to Department Gastroenterology occult blood in stool, endoscopic examination arranged. Colonoscopy showed sigmoid colon adenocarcinoma, esophagogastroduodenoscopy revealed speckled black pigmentation distributed from duodenal bulb second portion (Figure 1). Histopathology macrophages lamina propria containing pigmented granules negative Prussian blue stain 2). final diagnosis pseudomelanosis duodeni. Pseudomelanosis duodeni, characterized by brown spotty on esophagogastroduodenoscopy,1-3 first described 1976 Bisordi Kleinman.4 It occurs more commonly older women.3 pathogenesis is distinct melanosis coli remains poorly understood.1 Previous studies have shown association diabetes mellitus, renal disease, folate deficiency, gastrointestinal bleeding, ingestion food or oral agents sulfur.1-3 Thus, one hypothesis implicates accumulation sulfur mucosa caused drugs (eg, hydralazine, furosemide, hydrochlorothiazide) absorption, microhemorrhages, reduced clearance due decreased function.1 Usually, this incidental finding without obvious clinical symptoms. Microscopically, are found located propria.1, 3 Although all duodeni contains component, can still sometimes be negative, possibly because pigments sulfide form, do not react staining reagents.5 should distinguished metastatic malignant melanoma as it benign condition no evidence transformation future.1-3 Further investigation management required. All authors contribute stages article composition: data acquisition editing, manuscript drafting, revision. declare conflict interest. authorized publication patient's anonymity preserved article.