Transfusional Iron Overload and Choroid Plexus Hemosiderosis in a Pediatric Patient: Brain Magnetic Resonance Imaging Findings

Kim, Min Seon; Lee, Ha Young; Lim, Myung Kwan; Kang, Young Hye; Kim, Jun Ho; Lee, Kyung Hee

doi:10.13104/imri.2019.23.4.390

Cited by 3 publications

(5 citation statements)

References 9 publications

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“…Although iron deposition can occur anywhere in the body, CNS involvement is rare. Because brain cells are normally well shielded from iron deposition by the blood-brain-barrier (BBB), CNS hemochromatosis has been reported mainly outside the BBB, including the choroid plexus and the pituitary gland [7] . CNS hemochromatosis tends to be asymptomatic unless the pituitary gland is affected, which can result in hypopituitarism [ 6 , 12 , 13 ].…”

Section: Discussionmentioning

confidence: 99%

“…However, when these tissues' capacity is saturated, the excess iron is deposited in the heart, endocrine glands, skin, and joints. Although excess iron deposition in the central nervous system (CNS) is rare, the involvement of the choroid plexus, pituitary gland, cortical surfaces, and basal ganglia has been reported [3] , [4] , [5] , [6] , [7] . We report 2 cases of transfusion-induced hemochromatosis involving the choroid plexus and pituitary gland.…”

Section: Introductionmentioning

confidence: 99%

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Choroid plexus and pituitary gland hemochromatosis induced by transfusional iron overload: Two case reports

Fujii,

Matsuki,

Hamakawa

et al. 2024

Radiology Case Reports

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Choroid plexus and pituitary gland hemochromatosis induced by transfusional iron overload: Two case reports

Fujii,

Matsuki,

Hamakawa

et al. 2024

Radiology Case Reports

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“…Accumulation of iron in the liver correlates with the amount of transfused iron, occurring rather early, after as much as ten transfusions, while for the iron to be loaded in the heart and endocrine organs, high transferrin saturations are needed [ 22 ]. Moreover, choroid plexus iron depositions, at any stage of treatment, have rarely been described in literature [ 23 ]. In our patient, the peak ferritin level correlated with neurological and psychological deterioration and characteristic brain MRI findings of iron overload (Fig.…”

Section: Discussionmentioning

confidence: 99%

“…Orally active once-daily deferasirox is a frequently preferred iron chelator, especially in the outpatient setting [ 25 , 26 ], usually being well tolerated [ 27 ], as in our case. Nevertheless, regarding clinical presentation, neurological symptomatology could not be interpreted based on choroid plexus hemochromatosis, as it is mostly asymptomatic [ 23 ], so further elucidation was sought.…”

Section: Discussionmentioning

confidence: 99%

A challenging case of an adolescent and young adult patient with high-risk acute lymphoblastic leukemia: the need for a multidisciplinary approach: a case report

et al. 2022

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Background Adolescents and young adults diagnosed with acute lymphoblastic leukemia are treated according to pediatric-based regimens to achieve better results. However, implementation of intensive chemotherapy protocols in this age group is associated with increased treatment-related toxicities, affecting almost every organ and system. In this case, the focus of our interest was on rather rare entities: steroid-induced psychosis that seldom develops in children and adolescents, and choroid plexus hemosiderosis, infrequently identified as a first sign of iron overload. Case presentation The aim of this paper is to present a challenging case of a 15-year-old Caucasian male patient treated for high-risk acute lymphoblastic leukemia and who experienced various adverse incidents during intensive chemotherapy, thus necessitating a high-quality multidisciplinary approach. Slow minimal residual disease clearance was an additional concerning issue. Induction and re-induction were complicated by steroid-induced hyperglycemia that required multiple-week insulin. During consolidation, acute kidney injury on the basis of chronic kidney disease was verified, demanding subsequent drug dose modifications. By the end of re-induction, after dexamethasone cessation, infrequent steroid-induced psychosis, presented as incoherent speech, aggressive behavior, and mood swings, required intensive psychiatric support. Neurological evaluation of seizures revealed uncommon choroid plexus hemosiderosis by brain magnetic resonance imaging, warranting appropriate selection of iron chelation therapy in the context of preexisting nephropathy. Ultimately, iron deposits of moderate intensity were verified by liver magnetic resonance imaging, while heart tissue remained intact. The early diagnosis and adequate treatment of aforementioned difficult toxicities resulted in complete recovery of the patient. Conclusions Treating adolescents with high-risk acute leukemia and multiple therapy-related morbidities remains a challenge, even in the era of extensive and effective supportive therapy. Superior survival rates might be achieved by prompt recognition of both frequent and rarely encountered adverse episodes, as well as well-timed and appropriate management by a well-coordinated multidisciplinary team.

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“…8 The deposited iron preferentially accumulates in the gonadotropin-secreting cells and, less commonly, in growth hormone-secreting cells. 9 The most common manifestation is hypogonadism, followed by growth failure.…”

Section: Discussionmentioning

confidence: 99%

Transfusion-Related Hemochromatosis Involving Pituitary Gland in a Patient of Beta-Thalassemia Major

et al. 2022

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Introduction: Hemochromatosis of the pituitary gland is a form of iron overload disease which occurs in different clinical conditions related to multiple blood transfusions. Case Presentation: We present a case of secondary hemochromatosis involving the pituitary gland and choroid plexus in an eightyear-old female with imaging findings and a review of the relevant literature. Our patient has had a history of cessation of growth in height for the last 1 year. She was diagnosed with a thalassemia major at the age of 6 months. She has been on regular blood transfusions since then. Magnetic resonance imaging (MRI) revealed evidence of iron deposition in the pituitary gland. Conclusion: This diagnosis should be suspected on clinical presentation and history of multiple blood transfusions. It can be confirmed based on characteristic imaging findings. The patient should be strictly monitored with serum iron levels, and a tailored iron chelation therapy should be initiated.

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Transfusional Iron Overload and Choroid Plexus Hemosiderosis in a Pediatric Patient: Brain Magnetic Resonance Imaging Findings

Cited by 3 publications

References 9 publications

Choroid plexus and pituitary gland hemochromatosis induced by transfusional iron overload: Two case reports

Choroid plexus and pituitary gland hemochromatosis induced by transfusional iron overload: Two case reports

A challenging case of an adolescent and young adult patient with high-risk acute lymphoblastic leukemia: the need for a multidisciplinary approach: a case report

Transfusion-Related Hemochromatosis Involving Pituitary Gland in a Patient of Beta-Thalassemia Major

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