Marked secondary iron overload due to iron infusion, a case report

Abstract

A 75-year-old woman was admitted because of slight fever and hepatic dysfunction, but hepatitis virus infection and autoimmune hepatitis were ruled out from her blood data. At the age of 65, she had distal gastorectomy for gastric cancer. She had no history of blood transfusion, but had had iron infusion for about 30 months for iron deficiency anemia. On admission, her serum Fe and ferritin increased (210 μg/dl and 6600 ng/ml). An abdominal CT showed increased hepatic and splenic CT density, compared with those before iron infusion. An abdominal MRI showed low intensity both on T1 and T2 weighted images. In a liver biopsy specimen, hemosiderin granules were densely deposited in not only Kupffer cells but also hepatocytes. Based on these findings, we diagnosed her as secondary iron overload (secondary hemochromatosis), and started the i.m. injection of deferoxamine (500 mg/day) followed by phlebotomy. Serum ferritin has come down to 1199 ng/ml now.