Lanthanum carbonate
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Gastric toxicities: case report An 80-year-old man developed gastropathy associated with lanthanum phosphate deposition, gastric erosions, chronic gastritis and atrophic gastritis during treatment with lanthanum carbonate as a phosphate binder. The man, who had a history of chronic renal failure secondary to type 2 diabetes and was on dialysis for 4 years, started receiving oral lanthanum carbonate 750 mg/day as a phosphate binder. One year after initiation of treatment, he underwent upper gastrointestinal endoscopy due to epigastric discomfort. Endoscopic findings revealed rough mucosa along with a few white granular lesions in the lesser curvature of the gastric body with atrophic change, indicating atrophic gastritis. After 2 years of treatment initiation, endoscopic findings revealed white granular mucosa in the lesser curvature, which had slightly spread to the greater curvature of the lower gastric body and antrum. Also, multiple erosions were observed in the greater curvature of the lower gastric body, which indicated exacerbation of inflammation. After 3 years of treatment initiation, the erosions remained and the white granular mucosa had thickened and had spread to the upper gastric body. After 4 years of treatment initiation, the gastric mucosa with chronic inflammation was observed to be thicker and became more widespread and clear. Biopsy of the erosion in greater curvature was performed and the histopathology revealed atrophic mucosa, intestinal metaplasia and regenerative change. Several histiocytes containing crystalline or granular eosinophilic deposits were noted to be extensively infiltrating the lamina propria, suggesting the presence of inflammation. Scanning electron microscopy-energy dispersive X-ray spectroscopy showed the deposition of lanthanum and phosphorus in gastric mucosa. A biopsy sample taken from erosion in greater curvature revealed the infiltration of histiocytes, which gradually increased in the lamina propria of gastric mucosa and increased granular deposits. The crypt density reduced, and chronic gastritis, regenerative changes and intestinal metaplasia were more evident over time. He had no abdominal symptoms; therefore, gastrointestinal endoscopy follow-up was continued annually. A diagnosis of gastropathy associated with lanthanum phosphate deposition was established. Endoscopic and histological findings showed that the deposition of lanthanum and the number of histiocytes that infiltrated in the tissue had increased, and exacerbation of gastric inflammation during the treatment with lanthanum carbonate was noted. The findings implied that the lanthanum deposition resulted in the damage of the gastric mucosa. Ohno A, et al. Gastropathy associated with lanthanum phosphate deposition that was endoscopically tracked for 3 years. A case report. BMC Gastroenterology 20: 292, No. 1, 803515750 2020. Available from: URL: http://doi.org/10.1186/s12876-020-01424-7
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