The burden of survival: Secondary cardiac hemochromatosis as a complication of β-thalassemia major: A case report

Secondary cardiac hemochromatosis, or iron-overload cardiomyopathy (IOC), is the most severe and life-shortening complication of chronic transfusion therapy in β-thalassemia and other transfusion-dependent disorders. What begins as a life-saving intervention gradually becomes a silent threat. Clinical manifestations range from subclinical myocardial dysfunction to advanced heart failure, presenting as dilated or restrictive cardiomyopathy. Cardiac magnetic resonance imaging with T2* mapping is the most sensitive method for assessing myocardial iron burden and guiding management. Although iron chelation therapy remains the cornerstone of treatment, advanced disease may progress to end-stage heart failure, leaving heart transplantation as the final therapeutic option. We report the case of a young patient with β-thalassemia major who developed secondary multivisceral hemochromatosis with severe cardiac iron overload. Remarkably, cardiomyopathy showed substantial improvement following appropriate chelation therapy, highlighting the importance of early detection and timely intervention to prevent irreversible and potentially fatal iron-related complications. This case highlights the critical role of early cardiac MRI surveillance and sustained chelation therapy in reversing iron-overload cardiomyopathy and improving long-term outcomes, and preventing additional organ complications that may adversely affect prognosis.