Setake Maki, Tomiyama Mami, Arakaki Kyoko, Hokama Akira
Gastroenterology, Naha City Hospital, Japan.
Gastroenterology, Naha City Hospital.
Rev Esp Enferm Dig. 2024 Aug 1. doi: 10.17235/reed.2024.10638/2024.
A 49-year-old man presented for a screening esophagogastroduodenoscopy (EGD) as part of his registration for a donated kidney transplant. He had been on hemodialysis for 4 years for end-stage renal disease (ESRD) due to diabetic nephropathy. He was taking lanthanum carbonate (LaC) for hyperphosphatemia. A plain abdominal radiograph and CT showed the radiopaque appearance of LaC. EGD disclosed whitish spots resembling xanthomas in the stomach. Biopsies showed deposition of granular crystalline-like material and phagocytosis of these by multinucleated giant cells on HE staining. These histiocytes were positive for CD68. La deposition was suspected because of the long-term oral administration of LaC. LaC is commonly used to treat hyperphosphatemia in patients with ESRD. La deposition on the gastric mucosa presents with various endoscopic findings, including whitish spots, annular whitish mucosa, and diffuse whitish mucosa. The gastric endoscopic findings of La deposition reflect the infiltrated histiocytes and not the LC deposition itself. Our case highlights the importance of recognizing the rare but characteristic imaging findings of gastrointestinal La deposition in hemodialysis patients who are taking LaC.
一名49岁男性因登记接受捐赠肾移植而进行筛查性食管胃十二指肠镜检查（EGD）。他因糖尿病肾病导致终末期肾病（ESRD）已接受血液透析4年。他正在服用碳酸镧（LaC）治疗高磷血症。腹部平片和CT显示LaC呈不透X线表现。EGD显示胃内有类似黄色瘤的白色斑点。活检显示在苏木精-伊红（HE）染色下有颗粒状结晶样物质沉积以及多核巨细胞对这些物质的吞噬作用。这些组织细胞CD68呈阳性。由于长期口服LaC，怀疑有镧（La）沉积。LaC常用于治疗ESRD患者的高磷血症。La在胃黏膜的沉积有多种内镜表现，包括白色斑点、环形白色黏膜和弥漫性白色黏膜。La沉积的胃内镜表现反映的是浸润的组织细胞，而非LC沉积本身。我们的病例强调了在服用LaC的血液透析患者中识别胃肠道La沉积罕见但具有特征性影像学表现的重要性。
