Generalized Pruritus As a Symptom of Hyperferritinemia: A Case Report and Review of the Literature

Overview

Journal SAGE Open Med Case Rep

Publisher Sage Publications

Specialty General Medicine

Date 2022 Oct 24

PMID 36274857

Authors

Selena Osman

Richard M Haber

Affiliations

Soon will be listed here.

Abstract

Generalized pruritus can be the manifestation of many dermatologic and systemic diseases. However, it has been reported infrequently in the literature as a consequence of hyperferritinemia. We report the case of a 70-year-old male presenting to dermatology due to generalized pruritus in the absence of a rash, who was subsequently found to have a significantly elevated serum ferritin and transferrin saturation with otherwise normal iron studies. Hereditary hemochromatosis was ruled out on genetic testing; however, etiologies of secondary iron overload including alcohol use disorder and non-alcoholic fatty liver disease were present. The patient had minimal relief of his pruritus with topical corticosteroids, oral prednisone, and moisturizers. The only successful treatment was phlebotomy which resulted in complete resolution of his long-standing pruritus. We present the fifth case of generalized pruritus associated with hyperferritinemia, treated successfully with phlebotomy.

Citing Articles

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

Osman S, Haber R SAGE Open Med Case Rep. 2022; 10:2050313X221131861.

PMID: 36274857 PMC: 9583204. DOI: 10.1177/2050313X221131861.

References

Millington G, Collins A, Lovell C, Leslie T, Yong A, Morgan J . British Association of Dermatologists' guidelines for the investigation and management of generalized pruritus in adults without an underlying dermatosis, 2018. Br J Dermatol. 2018; 178(1):34-60. DOI: 10.1111/bjd.16117. View

Roh Y, Choi J, Sutaria N, Kwatra S . Itch: Epidemiology, clinical presentation, and diagnostic workup. J Am Acad Dermatol. 2021; 86(1):1-14. PMC: 8678917. DOI: 10.1016/j.jaad.2021.07.076. View

Osman S, Haber R . Generalized pruritus as a symptom of hyperferritinemia: A case report and review of the literature. SAGE Open Med Case Rep. 2022; 10:2050313X221131861. PMC: 9583204. DOI: 10.1177/2050313X221131861. View

Matos L, Batista P, Monteiro N, Ribeiro J, Cipriano M, Henriques P . Iron stores assessment in alcoholic liver disease. Scand J Gastroenterol. 2013; 48(6):712-8. DOI: 10.3109/00365521.2013.781217. View

Costa-Matos L, Batista P, Monteiro N, Henriques P, Girao F, Carvalho A . Hfe mutations and iron overload in patients with alcoholic liver disease. Arq Gastroenterol. 2013; 50(1):35-41. DOI: 10.1590/s0004-28032013000100008. View

Brigant F, Hautefeuille V, Dadban A, Lok C, Nguyen-Khac E, Chaby G . Generalized pruritus in dysmetabolic hyperferritinemia treated by phlebotomy. Dermatol Online J. 2015; 21(9). View

Hazin R, Tamimi T, Abuzetun J, Zein N . Recognizing and treating cutaneous signs of liver disease. Cleve Clin J Med. 2009; 76(10):599-606. DOI: 10.3949/ccjm.76A.08113. View

Patel A, Katz K, Gordon K . Cutaneous Manifestations of Chronic Liver Disease. Clin Liver Dis. 2020; 24(3):351-360. DOI: 10.1016/j.cld.2020.04.003. View

Kowdley K, Brown K, Ahn J, Sundaram V . ACG Clinical Guideline: Hereditary Hemochromatosis. Am J Gastroenterol. 2019; 114(8):1202-1218. DOI: 10.14309/ajg.0000000000000315. View

10.

Hamilton D, Gould D . Generalized pruritus as a presentation of idiopathic haemochromatosis. Br J Dermatol. 1985; 112(5):629. DOI: 10.1111/j.1365-2133.1985.tb15277.x. View

11.

Barisani D, Pelucchi S, Mariani R, Galimberti S, Trombini P, Fumagalli D . Hepcidin and iron-related gene expression in subjects with Dysmetabolic Hepatic Iron Overload. J Hepatol. 2008; 49(1):123-33. DOI: 10.1016/j.jhep.2008.03.011. View

12.

Neff L . Current directions in hemochromatosis research: towards an understanding of the role of iron overload and the HFE gene mutations in the development of clinical disease. Nutr Rev. 2003; 61(1):38-42. DOI: 10.1301/nr.2003.janr.38-42. View

13.

Kluger N, Raison-Peyron N, Rigole H, Bessis D, Blanc F, Guillot B . Generalized pruritus revealing hereditary haemochromatosis. Acta Derm Venereol. 2007; 87(3):277. DOI: 10.2340/00015555-0223. View

14.

McDonnell S, Preston B, Jewell S, Barton J, Edwards C, Adams P . A survey of 2,851 patients with hemochromatosis: symptoms and response to treatment. Am J Med. 1999; 106(6):619-24. DOI: 10.1016/s0002-9343(99)00120-5. View

15.

Nestler J . Hemochromatosis and pruritus. Ann Intern Med. 1983; 98(6):1026. DOI: 10.7326/0003-4819-98-6-1026_1. View

16.

Harrison-Findik D, Schafer D, Klein E, Timchenko N, Kulaksiz H, Clemens D . Alcohol metabolism-mediated oxidative stress down-regulates hepcidin transcription and leads to increased duodenal iron transporter expression. J Biol Chem. 2006; 281(32):22974-82. DOI: 10.1074/jbc.M602098200. View