Case:
A 50-year-old man with alcoholism was admitted to our hospital with a
week-long history of anorexia and vomiting. Physical examination
revealed jaundice. Laboratory findings showed increased hepatobiliary
enzymes (total bilirubin 5.42 mg/dL, aspartate aminotransferase 360 U/L,
alanine aminotransferase 166 U/L). Further evaluation revealed
hyperferritinemia (5,988 ng/mL) and elevated transferrin saturation
(96%). Magnetic resonance imaging revealed that liver and pancreas had
low signal intensity on the T2-weighted image (Figure 1A ) and
lower signal intensity on the gradient-echo in-phase image than the
out-of-phase image (Figure 1B, 1C ). Based on these findings,
acute alcoholic liver disease with secondary hemochromatosis was
diagnosed. Complete bed rest with alcohol cessation improved his
symptoms. He was discharged with an alcoholic rehabilitation program
appointment.
Hemochromatosis is a systemic disorder with excessive total body iron
storages and deposition1. Secondary hemochromatosis
occurs with iron overload that is not attributable to primary
abnormalities in iron metabolism. Although excessive alcohol consumption
induce iron metabolism disturbance, serum ferritin level over 1,000
ng/mL is considered rare2, which mandates close
follow-up. As excessive iron overload could be treated with iron
depletion therapy, clinicians should realize the importance of
evaluating the extent of iron overload in patients with known liver
diseases, including alcoholic liver disease.
Acknowledgments: None.
Conflict of Interest: The authors declare no conflicts of interest.
Authors’ Contribution:
KY and YN: wrote the first draft and managed all the submission process.
KH and FO: contributed to the clinical management of the patients and
revised the manuscript.