십이지장 가성흑색증 1예
A Case of Pseudomelanosis Duodeni
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초록
십이지장 점막에 많은 수의 작은 흑갈색 반점이 관찰되는 십이지장 가성흑색증은 드문 양성질환으로 아직 정확한 병태생리학적 기전이 밝혀지지는 않았지만, 만성 신부전, 고혈압, 철결핍성 빈혈 등의 기저 질환으로 인한 항고혈압제나 철분 제제 복용 등이 관련 있는 것으로 추정되고 있다. 저자들은 만성 심부전, 고혈압, 철결핍성 빈혈, 우울증이 있어 항고혈압제와 철분 제제를 복용하고 있는 환자에서 시행한 상부소화관 내시경검사에서 십이지장 점막에 색소침착이 관찰되었고, 점막생검에서 Prussian blue 염색과 Fontana-Masson 염색에 양성을 보이는 십이지장 가성흑색증 1예를 경험하였기에 문헌고찰과 함께 보고하는 바이다.
Abstract
Pseudomelanosis duodeni is a rare benign condition in which dark pigments accumulate in macrophages located in the lamina propria of the duodenal mucosa. Most reported cases had hypertension with or without chronic renal failure, and were taking antihypertensive agents and iron supplements. Therefore, it has been assumed that pseudomelanosis duodeni is associated with these medications. Our case was a 77 year-old female patient diagnosed as having hypertension, congestive heart failure, iron deficiency anemia, and depression, who had been treated with antihypertensive agents and iron supplement. Upper gastrointestinal endoscopy revealed many tiny discrete dark macules scattered throughout the first and second portions of the duodenum. Endoscopic mucosal biopsy disclosed macrophages with Prussian blue and Fontana- Masson stain positive pigments, which suggested that the nature of pigment was iron sulfide.
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