Sepsis and siderosis, Yersinia enterocolitica and hereditary haemochromatosis

Abstract

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.

Figure 1

Vital signs observation chart with temperature, pulse and blood pressure measurements taken prior to patient's transfer to our hospital. Unfilled arrows correspond to temperatures ≥38.5°C with the corresponding pulses also indicated by unfilled arrows. At body temperature ≥38.5°C, pulse rates would be expected to exceed 110 bpm.

Figure 2

Patient exhibiting bronzed skin (greyish hue).

Figure 3

CT scan, coronal view, showing multiple small hypodense lesions <5 mm in diameter (indicated by small arrows (↓)) that represent small liver abscesses. These lesions resolved following antibiotic treatment.