Gastropathy associated with lanthanum phosphate deposition that was endoscopically tracked for 3 years. A case report

• Published in: BMC gastroenterology 2020-08, Vol.20 (1), p.292-292, Article 292
• Main Authors: Ohno, Akiko, Miyoshi, Jun, Tanabe, Hidesato, Kusuhara, Mitsunori, Toki, Masao, Chiba, Tomohiro, Shimoyamada, Hiroaki, Shibahara, Junji, Hisamatsu, Tadakazu
• Format: Article
• Language: English
• Subjects: Aged, 80 and over; Biopsy; Case Report; Case reports; Dialysis; Endoscopy; Gastric cancer; Gastric Mucosa; Gastroenterology; Gastrointestinal endoscopy; Health aspects; Hemodialysis; Hemodialysis patients; Histiocyte; Humans; Inflammation; Kidney diseases; Kidney Failure, Chronic; Lanthanum; Lanthanum - adverse effects; Lanthanum carbonate; Male; Medical examination; Mucosal deposition; Patient outcomes; Patients; Phosphate; Phosphates; Phosphorus; Renal Dialysis; Scanning electron microscopy; Stomach; Stomach Diseases; Ulcers; X-ray spectroscopy
• ISSN: 1471-230X; 1471-230X
• DOI: 10.1186/s12876-020-01424-7

With the recent increased use of lanthanum carbonate, several cases of lanthanum phosphate deposition to gastric mucosa in dialysis patients have been reported. However, the endoscopic appearance of the early-stage lesion and the over-time alterations of endoscopic findings due to the progression of lanthanum phosphate deposition remain unclear. An 80-year-old man receiving dialysis and taking lanthanum carbonate as a phosphate binder over a 4-year period underwent upper gastrointestinal endoscopy four times beginning 1 year after initiation of treatment. The first endoscopic examination (after 1 year of exposure to lanthanum carbonate) revealed rough mucosa with a few areas of white granular mucosa. Over the 3 years of endoscopic follow-up, the white granular mucosa spread and multiple erosions appeared. Histopathological findings of biopsy specimens from an erosion showed extensive infiltration by histiocytes containing deposits. Scanning electron microscopy-energy dispersive X-ray spectroscopy (SEM-EDX) revealed that the presence of the deposits containing phosphorus and lanthanum in the gastric mucosa. On the basis of these results, the patient was diagnosed with gastropathy associated with lanthanum phosphate deposition. Over a 3-year period, endoscopic findings associated with lanthanum deposition gradually changed and expanded from the early stage.