Sevelamer Crystals in Patient With Severe Erosive Esophagitis and Multiple Superficial Ulcerations in the Duodenum

Extract

A 60-year-old woman with a clinical history of ESRD (end-stage renal disease) on kidney transplant list was taking oral sevelamer when she developed unexplained nausea, vomiting, gastric blood as well as severe erosive esophagitis and multiple superficial ulceration in the duodenum. This is the 8th reported case showing notable mucosal gastrointestinal abnormalities in a patient with chronic kidney disease taking sevelamer (a phosphate-lowering ion-exchange resin administered orally) in the literature. The following is a new entity first described in detail in 2013 with seven patient cases. The 2013 case study had shown all seven patients had a history of chronic kidney disease. These patients were taking oral sevelamer and had demonstrated mucosal injury. Awareness of this oral phosphate-binding resin (sevelamer) and recognition of its crystalline morphology is important for accurate diagnosis, reliable distinction from its histologic mimics, and management of the patient.