Pseudomelanosis duodeni is a rare entity characterised by dark pigmented 
intracellular granules seen within macrophages that lie within the lamina 
propria of the duodenal villi. There is no known treatment, and the clinical 
significance and long-term sequelae of this entity are unclear. We present a 
case of pseudomelanosis duodeni in a 54-year-old woman who presented with a 
1-month history of nausea, vomiting and non-bloody diarrhoea. The medical 
history was significant for diabetes mellitus type 2, end-stage renal disease 
status postkidney transplant, hypertension, anaemia of chronic disease and 
hypothyroidism. A gastroduodenal endoscopy revealed pigmented dark lesions in 
the duodenal mucosa. Biopsies from the second part of the duodenum and duodenal 
bulb showed pigmented macrophages in the lamina propria. The findings were 
consistent with duodenal melanosis. In spite of renal transplant with 
normalisation of renal function, the duodenal melanosis persists, which raises 
questions on the role of renal impairment in this entity.