S3030 Gastric Mucosal Calcinosis in a Patient With End-Stage Renal Disease (ESRD), Eucalcemia, and Euphosphatemia

Abstract

INTRODUCTION: Gastric Mucosal Calcinosis (GMC) is calcific deposition in the gastric mucosa that is only rarely observed on routine biopsies. The four broad categories of visceral calcinosis that may include gastric mucosa are metastatic, iatrogenic, dystrophic, and idiopathic. Occasionally gastric calcinosis can be encountered on upper endoscopy as irregular nodularity as described in this case. CASE DESCRIPTION/METHODS: We present a case of a 47-year-old caucasian male with a past medical history of end-stage renal disease on hemodialysis. The patient presented with non-healing right lower extremity wounds after a trans-metatarsal amputation. He developed hematochezia overnight with a drop in hemoglobin and hematocrit requiring blood transfusions. An endoscopy was done to find the cause which showed diffuse moderate inflammation characterized by congestion (edema) and erythema. Granularities were found in the entire examined stomach. Biopsies were taken for histology which revealed gastric mucosal calcinosis. The patient’s blood chemistry showed a Creatinine of 3.73, Calcium of 9.4, Magnesium of 1.7, Phosphorus of 4.3, and BUN of 21. On a 6-month analysis of his labs before the biopsy, he was found to be eucalcemic and euphosphatemic. He had no known underlying malignancy, had no history of chronic antacid use and 1,25-Hydroxy Vitamin D was found to be low. The patient’s hematochezia was later found to be a result of angiodysplasias in the cecum and was treated with argon laser. DISCUSSION: Calcific deposits in gastric mucosa are relatively rare and are a consequence of four main etiologies that include metastatic, iatrogenic, dystrophic, and idiopathic disease processes. Among these, metastatic calcinosis is the most common. Multiple primary factors have been shown to be associated with the pathogenesis of gastric mucosal calcinosis. These mainly include hypercalcemia and/or hypophosphatemia, elevated BUN in the setting of eucalcemia, organ transplants, gastric ulcers, chronic atrophic gastritis, and gastric neoplasms. In general, most cases of GMC are detected postmortem or on bone scintigraphy. GMC is rarely seen on endoscopy with biopsy showing white 1–2 mm nodules in a background of the thinned atrophic gastric mucosa.Figure 1.: Granularities in the entire examined stomach.