S2901 Yersinia enterocolitica Liver Abscesses as an Atypical Presentation of Hereditary Hemochromatosis

Abstract

Introduction: Hereditary hemochromatosis typically presents with organ dysfunction due to iron overload. Yersinia enterocolitica is an iron-utilizing microbe which hereditary hemochromatosis patients are predisposed to. We present an atypical presentation of hereditary hemochromatosis that was uncovered by liver abscesses caused by yersinia enterocolitica. This case highlights the importance of considering hereditary hemochromatosis in the setting of yersinia enterocolitica infection. Case Description/Methods: A 75 year old male with a PMH of diabetes mellitus, congestive heart failure, and complete heart block presented two months after pacemaker placement with nausea, anorexia, and subjective fevers. Physical exam was benign from a gastrointestinal standpoint. CT abdomen and pelvis showed multiple hepatic lesions. Biopsy confirmed abscess, and cultures grew yersinia enterocolitica. Initial ferritin was elevated above 4500. Blood cultures remained negative. Treatment with ceftriaxone and metronidazole was complicated by severe sepsis before resolution of abscesses were confirmed by CT. Post-infection, repeat ferritin remained elevated over 1000 with transferrin saturation elevated above 79%. Genetic testing confirmed homozygous C282Y gene mutations. The patient was advised to follow-up for possible phlebotomy. Discussion: Our case highlights that liver abscesses due to yersinia enterocolitica should provoke an investigation for hereditary hemochromatosis. Hereditary hemochromatosis likely contributed to multiple disease processes in our patient including heart failure, conduction disturbances, and diabetes mellitus. Early diagnosis of hereditary hemochromatosis has the potential to avoid later disease complications in patients and their families.Figure 1.: CT scan of liver abscesses from yersinia enterocolitica infection.