Generalized pruritus in dysmetabolic hyperferritinemia treated by phlebotomy

Abstract

This paper describes a case of pruritus caused by dysmetabolic hyperferritinemia treated by multiple phlebotomies.A 63-year-old man was followed for generalized pruritus, which was resistant to the usual treatments. He presented with metabolic syndrome. Physical examination showed only excoriations and lichenification on the skin. The serum ferritin was high at 1043 ng/ml, with transferrin saturation at 67%. The other biological investigations and genetic tests for hemochromatosis were negative.In spite of the dietary measures, the ferritin level was still high (853ng/ml). Magnetic resonance imaging confirmed hepatic iron overload.The association of hyperferritinemia, hepatic iron overload, and metabolic syndrome led to the diagnosis of dysmetabolic hyperferritinemia.Phlebotomies are an unusual treatment, but because the pruritus and hyperferritinemia were still present, phlebotomy was initiated. After 19 months, the patient reported improvement of his pruritus and normalization of ferritin levels.

Generalized pruritus as a symptom of hyperferritinemia: A case report and review of the literature

“…Generalized pruritus as a consequence of iron overload is an uncommon association reported in the literature. To our knowledge, there are only three reports of generalized pruritus as a consequence of hereditary hemochromatosis 2 – 4 and a single case associated with dysmetabolic hyperferritinemia 5 ( Table 1 ).…”

“…The association between hyperferritinemia and pruritus is difficult to establish based on the scarce literature that exists only in the form of case reports. [2][3][4][5] Few reviews on hereditary hemochromatosis cite pruritus as a symptom, and those that do reference the case reports discussed above. 7 Interestingly, a survey conducted in 2017 by Haemochromatosis UK looked at the symptomatology among patients with either (a) a diagnosis of hemochromatosis or (b) a genetic mutation for hemochromatosis.…”

Prevalence of Dermatological Problems in Beta-Thalasemic Patients at Al-Khidmat Hospital, Peshawar

“…The mechanism of disease that causes pruritus is unclear. It may be related to the releasing of histamine from tissue mast cells in response to cutaneous iron deposits 22 . Xerosis was observed in 34 (22.67%) patients in our study.…”