Introduction: Acute Liver injury attributed to dose-related acute iron poisoning has been a phenomenon with limited description in medical literature. Intravenously high doses of iron have shown serious liver toxicity, however cases have been predominantly shown in children. Here we present an adult case of drug induced liver injury after intravenous use of IV iron.
Case Description/Methods: An 86-year-old male with a past medical history of Stage I Colon Cancer status post resection in 1986, Heart Failure with Reduced Ejection Fraction, Atrial Fibrillation on Coumadin, and Coronary Artery Disease who presented to the ED for dyspnea on exertion and melena for one month with concern for hemodynamically unstable GI bleed.
Vitals revealed mild hypotension. Labs were significant for hemoglobin 7.2 g/dL, INR 4.5.
GI was consulted regarding this patient's acute GI bleed, and they followed the patient for the entirety of his admission. The patient was started on a PPI drip and frequent CBC monitoring and received a total of two transfusions as well as IV iron for a total of five days. On EGD, mild antral gastritis was identified however with biopsy taken to rule out H. pylori being negative. His hemoglobin and hematocrit would improve but his hospitalization would be complicated with progressive waxing and waning lethargy and worsening transaminitis, with maximal AST/ALT values being 2638/1929 (on admission AST 45, ALT 36). Iron studies were remarkable for elevated Iron 195, Iron Saturation 53%, and Ferritin elevated at 553.
CT abdomen and pelvis revealed no acute process, only an 8 mm focus of enhancement in the liver dome. Autoimmune, metabolic and infectious including hepatitis panel workup were negative. After Intravenous iron was discontinued, his liver function tests began to improve and normalize within two weeks.
Discussion: Iron is both an essential micronutrient and toxic to cellular processes in excess. The proposed mechanism of iron-toxicity induced tissue damage is free radical production and lipid per-oxidation. Systemic toxicity usually occurs from injury to the Liver and the cardiovascular system with cause of death from iron poisoning usually being shock or liver failure. Onset of Hepatotoxicity usually occurs within 12-96 hours of oral ingestion of iron however, intravenous iron overdoses are rare and limitedly reported in medical literature. We presented a case of a patient with worsening transaminitis secondary to IV Iron-induced acute liver injury.
