Abstract
A 54-year-old man underwent upper gastrointestinal endoscopy during a physical exam. Significant features of his medical history included 10 years of hypertension that had been controlled with hydralazine and enalapril therapies. The results of his physical examination and laboratory tests were normal. Endoscopy revealed a normal esophagus and stomach, but upper gastrointestinal endoscopy showed discrete black pigmentation from the duodenal bulb to the second portion (Figure A). Analysis of biopsy samples from the duodenum revealed that a black pigment had accumulated in macrophages of the lamina propria (Figure B).
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