Doll Brittany, Shapiro Chandler, Post Zoë, Al-Sabti Ram, Shariati Farnaz
Rush University Medical Center, Department of Internal Medicine, Chicago, Illinois.
Rush University Medical Center, Department of Internal Medicine, Division of Digestive Diseases and Nutrition, Chicago, Illinois.
Gastro Hep Adv. 2025 Jun 6;4(9):100715. doi: 10.1016/j.gastha.2025.100715. eCollection 2025.
We reported a 40-year-old female patient with a history of end-stage renal disease on sevelamer who presented with acute microcytic on chronic normocytic anemia without overt signs of gastrointestinal (GI) bleeding. Colonoscopy was notable for a friable and ulcerated mass in the cecum concerning for malignancy. However, histopathology of biopsies demonstrated inflammatory and regenerative changes with fragments of crystalline material compatible with sevelamer crystals. This case report emphasizes the consideration of sevelamer crystal-induced GI mucosal injury with occult GI bleeding as etiology of worsening anemia in patients with chronic kidney disease.
我们报告了一名40岁女性患者，她有终末期肾病病史，正在服用碳酸司维拉姆，出现了急性小细胞性贫血合并慢性正细胞性贫血，无明显胃肠道（GI）出血迹象。结肠镜检查发现盲肠有一个易碎且溃疡的肿物，怀疑为恶性肿瘤。然而，活检的组织病理学显示为炎症和再生性改变，伴有与碳酸司维拉姆晶体相符的结晶物质碎片。本病例报告强调，对于慢性肾病患者贫血加重的病因，应考虑碳酸司维拉姆晶体引起的GI黏膜损伤伴隐匿性GI出血。
