A case of pseudomelanosis duodeni that disappeared after discontinuation of iron pills

An 84-year-old woman underwent EGD for close examination of anemia. EGD revealed duodenal melanosis showing a pepper-sprinkled appearance in the bulb and the descending part of the duodenum (A, B). Berlin blue staining of the biopsy tissue showed that the pigmentation component was ferrous sulfide and that the deposits were localized to the apical portion of the duodenal villi (C, Berlin blue, orig. mag. x100), resulting in a characteristic pepper-sprinkled appearance on endoscopic images.