Case report of lanthanum deposition in the esophagus
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CASE REPORT
Case report of lanthanum deposition in the esophagus Tetsuya Tatsuta1 · Tatsuya Mikami2 · Daisuke Chinda1 · Kazuki Akitaya1 · Shohei Igarashi1 · Keisuke Hasui1 · Hidezumi Kikuchi1 · Hiroto Hiraga1 · Manabu Sawaya1 · Hirotake Sakuraba1 · Tadashi Shimoyama3 · Tosihiro Haga1,4 · Hiroshi Kijima4 · Shinsaku Fukuda1 Received: 18 October 2019 / Accepted: 16 December 2019 © Japanese Society of Gastroenterology 2019
Abstract A 69-year-old woman had received hemodialysis for chronic renal failure and was taking lanthanum carbonate since 63 years of age. She presented with appetite loss and nausea. We performed esophagogastroduodenoscopy, which revealed multiple longitudinal white plaques in the esophagus. Lesion biopsies showed lanthanum deposition, and lanthanum carbonate was found histologically by energy-dispersive X-ray spectroscopy. The plaques of this patient appeared like those of dabigatraninduced esophagitis, and may have occurred due to long-term contact of the esophageal epithelium with lanthanum carbonate because patient spent time in lying state. Although a few studies regarding lanthanum deposition in the stomach have been conducted, there are no reports on lanthanum deposition in the esophagus. This case suggests that the presence of longitudinal white plaques in the esophagus may indicate lanthanum deposition. Keywords Lanthanum carbonate · Multiple longitudinal white plaques · Energy-dispersive X-ray spectroscopy
Introduction
Case report
Lanthanum (La) carbonate is a phosphate binder used to treat hyperphosphatemia in patients with chronic renal failure. La is considered safe because absorption into the gastrointestinal tract is reported to be minimal. La deposition in the gastric or duodenal mucosa of patients taking oral La carbonate has recently been reported. Esophagogastroduodenoscopy (EGD) for patients with gastric La deposition demonstrated a diffuse whitish gastric mucosa [1–6]. To our knowledge, esophageal La deposition has not yet been reported. This is the first report describing a case of La deposition in the epithelium of the esophageal mucosa.
A 69-year-old woman was diagnosed with chronic renal failure and had received hemodialysis for 10 years. She was under treatment with La carbonate (750 mg/day) for prevention of hyperphosphatemia since 63 years of age. She visited our hospital because of appetite loss and nausea. Computed tomography (CT) did not reveal the cause of appetite loss and nausea. EGD was performed to investigate the cause of her symptoms. EGD demonstrated multiple longitudinal white plaques in the upper to lower esophagus (Fig. 1a, b). White gastric mucosa, suggesting gastric La deposition in the stomach, was not observed (Fig. 1c). A biopsy from the esophageal mucosa showed deposition of an eosinophilic structure (Fig. 2a, b). Scanning electronic microscopy (SEM) showed an amorphous substance of high electron density in the epithelium of the esophageal mucosa (Fig. 3a). La was histologically found in the esophageal mucosa by energy-dispersive X-ray spectro
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