Case of Week Home
2 February 2012 - Case of the Week #231
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Thanks to Dr. Jamie Shutter, East Carolina University Brody School of Medicine, for contributing this case. To contribute a Case of the Week, follow the guidelines on our Case of the Week page.
(1) Check out our new CME page, which has a link on the left side of the Home page.
(2) We have increased our Case of the Week payment for contributors to $50. Just send us diagnostic images, the diagnosis and a brief clinical history. We will write up the discussion (unless you want to). Right now, our queue is relatively short, so cases submitted will be posted soon. Send your materials to NatPernick@hotmail.com
(3) We posted an article on our Management Page, Thoughts for the New Year (2012), by Mick Raich, Vachette Pathology, click here.
Case of the Week #231
94 year old woman with GI bleed presents for upper and lower endoscopy. Endoscopist notes “spotty hyperpigmentation throughout duodenum without other associated abnormalities."
What is your diagnosis?
Melanosis duodeni, also known as pseudomelanosis duodeni, is due to brown-black pigment in macrophages in the lamina propria of the proximal duodenum. It is often, but not always, identified at endoscopy. It is due to iron or sulfur (J Formos Med Assoc 1995;94:632), and may be associated with oral iron intake, hypertension, diabetes or end stage renal disease (Endoscopy 2008;40:165). It is not associated with laxative abuse (J Clin Gastroenterol 1988;10:127). It is also not associated with lipofuscin pigment, which is identified in melanosis coli.
Melanosis duodeni has no known clinical significance.
Nat Pernick, M.D., President
and Liz Parker, B.A., Associated Medical Editor
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