Pseudomelanosis duodeni in an adolescent male: case report and review of the literature.

Pseudomelanosis duodeni is rarely seen in children. It manifests endoscopically as peppery speckles in the duodenal mucosa. This pigment corresponds principally to accumulation of ferrous sulfide in macrophages within the lamina propria. We report the case of a 16-year-old boy with ectodermal dysplasia who underwent renal transplantation for vesicoureteral reflux and later developed epigastric pain. Endoscopic and pathologic findings in the duodenal mucosa were typical of pseudomelanosis duodeni. A review of the literature reveals shared clinical features among reported adult and pediatric cases, including chronic renal failure, use of antihypertensive medication and oral iron supplementation, and/or presence of gastric hemorrhage.