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Case Report
Sevelamer-associated gastric erosions in a hemodialysis patient: A case report and brief literature review
1 MD, PhD(c), Nephrologist, Department of Nephrology, General Hospital of Lamia, Lamia, Greece
2 MD, Pathologist, Department of Pathology, General Hospital of Lamia, Lamia, Greece
3 MD, Director of Gastroenterology, Department of Gastroenterology, General Hospital of Lamia, Lamia, Greece
4 MD, Microbiologist, Department of Microbiology, General Hospital of Lamia, Lamia, Greece
5 MD, MSc, Nephrologist, Department of Nephrology, General Hospital of Lamia, Lamia, Greece
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Simella Provatopoulou
End Papasiopoulou Str. 35 100, Lamia,
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Article ID: 101149Z01SP2020
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Provatopoulou S, Pathiaki I, Polyzou P, Vogiatzi A, Lazarou D. Sevelamer-associated gastric erosions in a hemodialysis patient: A case report and brief literature review. Int J Case Rep Images 2020;11:101149Z01SP2020.ABSTRACT
Introduction: The use of sevelamer as a phosphate binder in chronic kidney disease patients with hyperphosphatemia is typically associated with mild gastrointestinal adverse events. However, recent reports indicate that its effect may be considerably more damaging.
Case Report: We describe the incidental finding of sevelamer crystals in the gastric mucosa of a 55-year-old female patient on maintenance hemodialysis. The patient was subjected to gastroscopy as part of anemia investigation which revealed mild gastritis and presence of linear mucosal erosions at the pyloric antrum. Pathology reported extended granulomatous foreign body response in the gastric mucosa. Giant cell histiocytes were identified containing crystalline material with irregularly shaped fish scales. Pathology findings were consistent with lesions described in recent literature as induced by sevelamer crystals. Sevelamer administration was immediately stopped and a follow-up gastroscopy after 12 months showed improvement of the lesions.
Conclusion: A thorough literature review reveals that sevelamer-associated mucosal injury has been identified as the underlying cause of several acute gastrointestinal events as well as chronic persistent symptomatology. Currently, its prevalence in hemodialysis patients is largely unknown due to lack of routine endoscopic assessment, however it may be significantly higher than expected. Therefore, timely diagnosis and appropriate management of sevelamer-associated injury require a high index of clinical suspicion, especially for patients with a history of long-term sevelamer use.
Keywords: Crystalline material, Fish scales, Mucosal injury, Sevelamer crystals
SUPPORTING INFORMATION
Acknowledgments
We thank the pathologist Georgios Kyriakopoulos, MD, Department of Pathology, Evaggelismos General Hospital of Athens, for kindly providing pathology images.
Author ContributionsSimella Provatopoulou - Conception of the work, Design of the work, Drafting the work, Revising the work critically for important intellectual content, Final approval of the version to be published, Agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.
Irini Pathiaki - Acquisition of data, Analysis of data, Revising the work critically for important intellectual content, Final approval of the version to be published, Agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.
Paraskevi Polyzou - Acquisition of data, Analysis of data, Revising the work critically for important intellectual content, Final approval of the version to be published, Agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.
Apostolia Vogiatzi - Revising the work critically for important intellectual content, Final approval of the version to be published, Agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.
Dimitrios Lazarou - Revising the work critically for important intellectual content, Final approval of the version to be published, Agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.
Guarantor of SubmissionThe corresponding author is the guarantor of submission.
Source of SupportNone
Consent StatementWritten informed consent was obtained from the patient for publication of this article.
Data AvailabilityAll relevant data are within the paper and its Supporting Information files.
Conflict of InterestAuthors declare no conflict of interest.
Copyright© 2020 Simella Provatopoulou et al. This article is distributed under the terms of Creative Commons Attribution License which permits unrestricted use, distribution and reproduction in any medium provided the original author(s) and original publisher are properly credited. Please see the copyright policy on the journal website for more information.
