Adeniran Olanrewaju, Adekolu Ayowumi Andrew, Kirkpatrick Joshua, Cohen Ethan M, Sulaiman Abdullahi Adedotun, Marwizi Farirai, Kovac Zachary, Alqinai Budoor, Khan Raja Samir
Division of Internal Medicine, West Virginia University, Morgantown, WV, USA.
Division of Pathology, West Virginia University, Morgantown, WV, USA.
Case Rep Gastroenterol. 2025 May 7;19(1):328-334. doi: 10.1159/000545562. eCollection 2025 Jan-Dec.
Pseudomelanosis duodeni (PD) is a rare condition characterized by multiple pigmented speckles in the duodenum. It is typically seen in adults and has been associated with chronic kidney disease, hypertension, iron deficiency anemia, diabetes mellitus, and the use of medications like oral iron, hydralazine, furosemide, and hydrochlorothiazide. While oral iron is common, only one documented PD has been associated with intravenous (IV) iron supplementation.
A 69-year-old female with multiple comorbidities, including stage 4 chronic kidney disease and hypertension, presented with persistent nausea and vomiting. An esophagogastroduodenoscopy (EGD) revealed diffuse, dark speckling throughout the duodenal mucosa. Biopsies confirmed PD through Perl Prussian blue and Fontana-Masson staining, which detected iron in black/brown pigmentations within macrophages. The patient received a 5-week course of weekly intravenous iron supplementation 6 months before presentation. Previous EGD 7 and 5 years earlier showed no evidence of PD despite the patient being on sulfur-containing antihypertensive medications. This case suggests a likely interplay between IV iron and sulfur-containing medications in PD development.
While PD has been associated with multiple comorbidities and certain medications, the causal mechanism remains unclear. PD likely entails defective iron transport and iron sulfide accumulation within duodenal macrophages. This case highlights the potential role of IV iron supplementation in PD development, even in the absence of oral iron intake. PD is regarded as a benign condition with no specific guidelines for treatment or follow-up, but a biopsy is crucial to rule out other differential diagnoses and avoid unwanted interventions.
十二指肠假黑色素沉着症（PD）是一种罕见病症，其特征为十二指肠出现多个色素沉着斑点。它通常见于成年人，与慢性肾脏病、高血压、缺铁性贫血、糖尿病以及口服铁剂、肼屈嗪、呋塞米和氢氯噻嗪等药物的使用有关。虽然口服铁剂很常见，但仅有一例记录在案的PD与静脉注射（IV）铁剂补充有关。
一名69岁女性，患有多种合并症，包括4期慢性肾脏病和高血压，出现持续恶心和呕吐症状。食管胃十二指肠镜检查（EGD）显示整个十二指肠黏膜弥漫性、深色斑点。活检通过Perl普鲁士蓝和Fontana-Masson染色确诊为PD，该染色在巨噬细胞内的黑色/棕色色素沉着中检测到了铁。患者在就诊前6个月接受了为期5周的每周一次静脉铁剂补充疗程。尽管患者服用含硫抗高血压药物，但7年和5年前的先前EGD检查均未显示PD迹象。该病例提示静脉铁剂与含硫药物在PD发生过程中可能存在相互作用。
虽然PD与多种合并症和某些药物有关，但其因果机制仍不清楚。PD可能涉及十二指肠巨噬细胞内铁转运缺陷和硫化铁积累。该病例突出了静脉铁剂补充在PD发生中的潜在作用，即使在未摄入口服铁剂的情况下也是如此。PD被视为一种良性病症，没有具体的治疗或随访指南，但活检对于排除其他鉴别诊断和避免不必要的干预至关重要。
