We present the case of an 82-year-old man with a medical history of hypertension, dyslipidemia, diabetes mellitus, chronic renal failure, ischemic heart disease and iron deficiency anemia. He was under therapy with hydralazine, furosemide, amlodipine, valsartan, nitroglycerin patches, bisoprolol, omeprazole, doxazosin, human insulin and oral iron. The patient presented at our Institution with melena. Initial gastroscopy showed fresh blood and a gastric angiodysplasia that was treated with argon plasma coagulation (APC). Three months later, he suffered from a new episode of bleeding and consequently, a small bowel capsule endoscopy (SBCE) was indicated. It was reported a gastric and duodenal mucosa with an intense speckled black pigmentation, compatible with pseudomelanosis.