Pseudomelanosis Duodeni

A 55-year-old male with history of coronary artery disease, chronic kidney disease stage 4, diabetes mellitus, uncontrolled hypertension (on multiple antihypertensive medications), and iron deficiency anemia was referred for esophagogastroduodenoscopy (EGD) for evaluation of intractable nausea and vomiting. EGD showed black speckled pigmentation of the duodenal mucosa (Figure 1). Duodenal biopsy revealed hemosiderin deposition in the lamina propria of the duodenum, consistent with a diagnosis of pseudomelanosis duodeni (PMD; Figure 2).