Table of Contents Author Guidelines Submit a Manuscript
Anemia
Volume 2011, Article ID 184748, 4 pages
http://dx.doi.org/10.1155/2011/184748
Case Report

Iron Deficiency Anemia in Adult Onset Still's Disease with a Serum Ferritin of 26,387 μg/L

1Department of Internal Medicine, New York Methodist Hospital, 506 Sixth Street, Brooklyn, NY 11215, USA
2Division of Hematology-Oncology, Department of Internal Medicine, New York Methodist Hospital, 506 Sixth Street, Brooklyn, NY 11215, USA
3Division of Hematology, Department of Internal Medicine, New York Methodist Hospital, 506 Sixth Street, Brooklyn, NY 11215, USA
4Weill Cornell Medical College of Cornell University, 1300 York Avenue, New York, NY 10065, USA

Received 16 November 2010; Accepted 5 March 2011

Academic Editor: Aurelio Maggio

Copyright © 2011 Sheetal Patel et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Serum ferritin rises in the anemia of chronic inflammation reflecting increased iron storage and other changes mediated by inflammation. When iron deficiency coexists, the ferritin may not always decline into the subnormal range. We describe the rare interaction of iron deficiency with the extreme hyperferritinemia characteristic of adult onset Still's disease. The combination has clinical relevance and allows deductions about the presence of serum ferritin at 26,387 μg/L despite obvious iron depletion. The diagnosis of iron deficiency anemia was delayed and became fully obvious when her Still's disease remitted and serum ferritin decreased to 6.5 μg/L. The coexistence of iron deficiency should be considered when evaluating a patient with anemia of chronic inflammation even when the ferritin level is elevated several hundredfold. Further insights on ferritin metabolism in Still's disease are suggested by the likelihood that the patient's massive hyperferritinemia in the acute phase of Still's disease was almost entirely of the iron-free apoferritin form.