Pseudomelanosis duodeni is rarely seen in children. It manifests endoscopically 
as peppery speckles in the duodenal mucosa. This pigment corresponds principally 
to accumulation of ferrous sulfide in macrophages within the lamina propria. We 
report the case of a 16-year-old boy with ectodermal dysplasia who underwent 
renal transplantation for vesicoureteral reflux and later developed epigastric 
pain. Endoscopic and pathologic findings in the duodenal mucosa were typical of 
pseudomelanosis duodeni. A review of the literature reveals shared clinical 
features among reported adult and pediatric cases, including chronic renal 
failure, use of antihypertensive medication and oral iron supplementation, 
and/or presence of gastric hemorrhage.