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Endoscopy
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Clofazimine enteropathy: a case of pigmentation of the whole small intestine caused by clofazimine
http://orcid.org/0009-0007-7202-9397
Zhang Huan MD
Peng Qinghui Dr.
Zhao Xinhua Dr.
He Yuanjing Dr.
Liu Jun Dr.
1 536557 Department of Gastroenterology, Mianyang Central Hospital, Mianyang, China
Correspondence Huan Zhang, MD Department of Gastroenterology, Mianyang Central HospitalNo.12 Changjia Lane, Jingzhong StreetFucheng, Mianyang, 621000 SichuanChina719975994@qq.com
03 7 2024
12 2024
1 7 2024
56 Suppl 1 E578E579
The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/).
2024
The Author(s).
https://creativecommons.org/licenses/by/4.0/ This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
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pmcClofazimine is mainly used for the treatment of neoplastic leprosy, and can also be used in combination with other anti-tuberculosis drugs to treat multidrug-resistant tuberculosis.

As is well known, clofazimine can within weeks cause skin pigmentation in 75% to 100% of patients, or, uncommonly, ichthyosis 11 . One of the most serious gastrointestinal side effects of clofazimine is deposition of black-purple crystals in the small bowel lamina propria, which leads to hyperpigmentation in the intestines. This most serious side effect of clofazimine, although rare, can result in severe or even fatal enteropathy 22 . We report a case of intestinal injury caused by clofazimine. After timely diagnosis and cessation of medication, the patient’s condition has significantly improved.

Our 32-year-old patient with drug-resistant tuberculosis developed abdominal pain after receiving anti-tuberculosis treatment with pyrazinamide, clofazimine, levofloxacin, and iminicotinamide for 16 months. Physical examination revealed that the skin on his back was reddish brown ( Fig. 1Fig. 1 ), and the anterior tibial skin of both his lower limbs showed fish-scale-like changes ( Fig. 2Fig. 2 ). Colonoscopy showed melanosis in the terminal ileum. The pathological report stated that tissue cells could be seen in the lesion area, and crystal-like substances could be seen inside ( Fig. 3Fig. 3 ). Capsule endoscopy showed continuous pigmentation of the jejunum and ileum, with pigmentation of the jejunum being prominent ( Video 1Video 1 ).

Fig. 1 Fig. 1 Clofazimine caused reddish-brown pigmentation of the skin on the back of a patient with intestinal injury.

Fig. 2 Fig. 2 Clofazimine caused fish-scale-like changes (ichthyosis) in the skin of both lower limbs in a patient with intestinal injury.

Fig. 3 Fig. 3 The pathological report on the biopsy of the distal segment of the ileum identified moderate chronic inflammation of the mucosa, with infiltration of lymphocytes, plasma cells, and scattered eosinophils. Tissue cells can be seen in the lesion area, and crystal-like substances can be seen inside.

Continuous pigmentation of the jejunum and ileum, with pigmentation of the jejunum being prominent.

Video 1

Video 1

Clofazimine treatment was stopped, and within 5 months the patient’s abdominal pain disappeared and the pigmentation and fish-scale-like changes in the back and lower limbs decreased.

Endoscopy_UCTN_Code_CCL_1AB_2AH_3AB

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Acknowledgement

First of all, I would like to give my heartfelt thanks to all the people who have ever helped me in this paper. I am also extremely grateful to all my friends who have kindly provided me assistance and companionship in the course of preparing this paper. In addition, many thanks go to my family for their unfailing love and unwavering support. Finally, I am really grateful to all those who devote much time to reading this thesis and give me much advice, which will benefit me in my later study.

Conflict of Interest The authors declare that they have no conflict of interest.
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References

1 Lawrence J Brandt MD An unusual cause of small-intestine mucosal pigmentation Gastrointest Endosc 2011 73 1285 1286 21354567
2 Arbiser JL Moschella SL Clofazimine: a review of its medical uses and mechanisms of action J Am Acad Dermatol 1995 32 241 247 10.1016/0190-9622(95)90134-5 7829710
