Infection with Yersinia enterocolitica in patients with iron overload.

Infection with Yersinia enterocolitica in patients with iron overload Yersinia enterocolitica commonly causes fever and mild gastroenteritis' but occasionally causes severe illness, particularly in patients with iron overload in whom its virulence is enhanced.2Desferrioxamine used therapeutically may potentiate the growth of yersinia, which uses desferrioxamine as a siderophore to chelate iron.3We describe three patients with transfusional haemosiderosis and infection with Y enterocolitica. Case reports CASE 1A 25 year old white man with congenital sideroblastic anaemia, which had been diagnosed in 1965 and who had subsequently received regular blood transfusions (450 units) and subcutaneous desferrioxamine (serum ferritin 2460 pg/I), was admitted with symptoms of anaemia, three days of fever (395°C), slight diarrhoea, which he initially denied, but no abdominal pain.He had hepatomegaly (10 cm) and slight abdominal tenderness.His haemo- globin concentration was 53 g/l with normal white cells.The day after admission he started to receive a blood transfusion ofthree units with 6 g ofdesferrioxamine.Within eight hours he had severe diarrhoea, after 12 hours severe dyspnoea due to a persistent metabolic acidosis (bicarbonate 13 mmol (mEq)/l), and by 40 hours he had died.Intravenous penicillin, gentamicin, metronidazole, and rehydration were given to no avail.Necropsy showed an ulcer in the terminal ileum, multiple tiny colonic ulcers, and grossly enlarged purulent mesenteric lymph nodes.