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CASE REPORT
Sepsis and siderosis, Yersinia enterocolitica and hereditary haemochromatosis
  1. Phoebe A Thwaites1,
  2. Marion L Woods2
  1. 1Department of Victorian Liver Transplant Unit, Austin Health, Heidelberg, Victoria, Australia
  2. 2Royal Brisbane and Women's Hospital, Herston, Queensland, Australia
  1. Correspondence to Dr Marion L Woods, marion.woods{at}health.qld.gov.au

Summary

A 60-year-old woman was admitted with sepsis, relative bradycardia, CT evidence of numerous small liver abscesses and ‘skin bronzing’ consistent with hereditary haemochromatosis (HH). Yersinia enterocolitica O:9 infection was confirmed by serology specimens taken 10 days apart. Iron overload was detected, and homozygous C282Y gene mutation confirmed HH. Liver biopsy revealed grade IV siderosis with micronodular cirrhosis. Haemochromatosis is a common, inherited disorder leading to iron overload that can produce end-organ damage from excess iron deposition. Haemochromatosis diagnosis allowed aggressive medical management with phlebotomy achieving normalisation of iron stores. Screening for complications of cirrhosis was started that included hepatoma surveillance. Iron overload states are known to increase patient susceptibility to infections caused by lower virulence bacteria lacking sophisticated iron metabolism pathways, for example, Yersinia enterocolitica. Although these serious disseminated infections are rare, they may serve as markers for occult iron overload and should prompt haemochromatosis screening.

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Footnotes

  • Contributors PAT wrote the initial draft of the case and performed the initial literature review and provided overview of haemochromatosis. MLW involved in the patient diagnosis and care and edited and revised the manuscript.

  • Competing interests None declared.

  • Patient consent Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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