Introduction
Lanthanum carbonate is one of the most potent phosphate binders. It
binds dietary phosphate and forms insoluble complexes which are
eliminated through the gastrointestinal tract. It is used to prevent
elevation of serum phosphate especially in dialysis dependent patients.
Patients treated with lanthanum carbonate show depositions predominantly
in the gastric mucosa. Those depositions can be seen on gross
examination as white spots, ringlike white discoloration, or diffuse
white discoloration of the mucosa. Scanning electron microscopy and
energy dispersive X-ray can be used to further identify lanthanum and
phosphate deposition in the mucosa. The whitish depositions can be seen
as early as three months after first taking lanthanum carbonate. They
also seem to intensify over time. There is a positive correlation
between the amount of lanthanum intake and its accumulation. The
depositions seem to persist for a long time.
We herein report a case of gastric lanthanosis in a patient with a
cessation of lanthanum carbonate over 7 years, supporting the concept of
permanent depositions. This could suggest that the depositions are
irreversible or at least persist for a long time. They also seem to lead
to symptoms even years after cessation. Clinicians should be aware of
this fact and specifically look for specific endoscopic changes and take
biopsies if they have a patient with epigastric discomfort and a history
of lanthanum medication.