Chao Eugene S, Yoshikawa Gene, Qing Xin, Huang Charity
Internal Medicine, Harbor University of California Los Angeles Medical Center, Torrance, USA.
Hematology Oncology, Harbor University of California Los Angeles Medical Center, Torrance, USA.
Cureus. 2025 Aug 13;17(8):e90020. doi: 10.7759/cureus.90020. eCollection 2025 Aug.
Ferritin is the protein that serves as the main mechanism for iron storage. It can also be an acute-phase reactant, which may rise in response to inflammation, infection, injury, autoimmune disease, or malignancy. Therefore, when evaluating ferritin levels, it is important to consider both iron storage and potential underlying conditions that could cause hyperferritinemia. We report a case of an elderly man in his late 80s who had elevated ferritin levels for years before ultimately being diagnosed with metastatic neuroendocrine carcinoma. The initial diagnosis was suspected to be due to iron overload from iatrogenic causes, but despite discontinuation of iron supplementation, the patient continued to have hyperferritinemia. Broad differential diagnoses were considered, including hereditary hemochromatosis, sideroblastic anemia, thalassemia, viral infection, hereditary hyperferritinemia, myelodysplastic syndromes with ineffective iron regulation, hemophagocytic lymphohistiocytosis, and other autoimmune phenomena. However, workup was negative. Ultimately, bone marrow biopsy was performed, which revealed poorly differentiated metastatic carcinoma with neuroendocrine differentiation.
铁蛋白是作为铁储存主要机制的蛋白质。它也可以是一种急性期反应物，可因炎症、感染、损伤、自身免疫性疾病或恶性肿瘤而升高。因此，在评估铁蛋白水平时，重要的是要同时考虑铁储存以及可能导致高铁蛋白血症的潜在基础疾病。我们报告了一例80多岁晚期的老年男性病例，他多年来铁蛋白水平一直升高，最终被诊断为转移性神经内分泌癌。最初的诊断怀疑是医源性原因导致的铁过载，但尽管停止了铁补充，患者仍持续存在高铁蛋白血症。考虑了广泛的鉴别诊断，包括遗传性血色素沉着症、铁粒幼细胞性贫血、地中海贫血、病毒感染、遗传性高铁蛋白血症、铁调节无效的骨髓增生异常综合征、噬血细胞性淋巴组织细胞增生症以及其他自身免疫现象。然而，检查结果均为阴性。最终进行了骨髓活检，结果显示为低分化转移性癌，具有神经内分泌分化。
