Clofazimine-associated enteropathy.

Competing Interests: Disclosure Both authors disclosed no financial relationships. Commentary Pseudomelanosis is the most common cause of intestinal pigmentation. However, the endoscopist should be aware of other causes of intestinal pigmentation. In the current case, a 36-year-old man underwent a colonoscopy for the evaluation of abdominal pain that had started 7 months after the initiation of treatment for pulmonary tuberculosis. Colonoscopy revealed a purple appearance of the mucosa in the terminal part of the ileum, and analysis of biopsy specimens revealed scattered eosinophils and macrophages with crystal deposition in the lamina propria. Given these findings and the patient’s exposure to the medication clofazimine for tuberculosis treatment, a diagnosis of clofazimine-associated enteropathy was made. Diagnosis was further confirmed with resolution of the intestinal findings, 30 months after the medication was stopped. Although skin pigmentation is a well-known side effect of clofazimine, it is important that physicians understand the potential GI side effects as well. This case highlights the importance of knowing a patient’s medical and treatment history in order to accurately diagnose and treat unusual endoscopic findings. Brianna Shinn, MD, Assistant Professor of Clinical Medicine, Perelman School of Medicine, Division of Gastroenterology and Hepatology, Hospital of University of Pennsylvania, Philadelphia, Pennsylvania, USA Amy Tyberg, MD, FASGE, FACG, GIE Senior Associate Editor