title: Haemophilia-associated Yersinia pseudotuberculosis serotype O:1 septicaemia: the role of iron.
abstract: Septicaemia and septic arthritis due to Yersinia pseudotuberculosis are rare diseases with high mortality rates. Reactive arthritis caused by Yersinia infection is a well-known complication but septic arthritis is found at a much lower frequency. It has already been established that there is a relationship between yersiniosis and iron but there are currently no data about yersiniosis and haematological disorders such as haemophilia. We report a case of septic arthritis due to Y. pseudotuberculosis as an early manifestation of Yersinia septicaemia in a patient with severe haemophilia A. The patient had no history of immunosuppression and presented with a repeat case of haemarthrosis with a fever of unknown origin. Furthermore, he suffered from acute-on-chronic renal failure and non-ST segment elevation myocardial infarction. Arthrocentesis and blood culture tested positive for Y. pseudotuberculosis. Iron deposits at localized sites in the synovium in patients with haemophilia have been described, and as Yersinia infections are common in patients with secondary iron overload, we felt that a review of the literature was in order. Severe Yersinia infection is often associated with iron overload, a condition that might occur as a side effect in the treatment of haemophilia. Iron overload, which plays an important role in the pathogenesis of haemophilic arthropathy, may have increased the virulence of Y. pseudotuberculosis in the present case.
authors.affiliation: Department of Infectious Diseases, Heidelberg University Hospital, Medical Microbiology and Hygiene, Im Neuenheimer Feld 324, 69120 Heidelberg, Germany.
authors.forename: Alexander
authors.initials: A
authors.lastname: Mischnik
authors.affiliation: Department of Cardiology, Heidelberg University Hospital, Im Neuenheimer Feld 410, 69120 Heidelberg, Germany.
authors.forename: Tillman
authors.initials: T
authors.lastname: Dahme
authors.affiliation: Department of Cardiology, Heidelberg University Hospital, Im Neuenheimer Feld 410, 69120 Heidelberg, Germany.
authors.forename: Raffi
authors.initials: R
authors.lastname: Bekeredjian
authors.affiliation: Department of Infectious Diseases, Heidelberg University Hospital, Medical Microbiology and Hygiene, Im Neuenheimer Feld 324, 69120 Heidelberg, Germany.
authors.forename: Stefan
authors.initials: S
authors.lastname: Zimmermann
mesh_terms: D000368:Aged; D001170:Arthritis, Infectious / Q000382:microbiology*; D016470:Bacteremia / Q000382:microbiology*; D017809:Fatal Outcome; D006467:Hemophilia A / Q000150:complications*; D006801:Humans; D007501:Iron / Q000378:metabolism*; D008297:Male; D012703:Serotyping; D015011:Yersinia pseudotuberculosis / Q000145:classification / Q000235:genetics / Q000472:pathogenicity*; D015012:Yersinia pseudotuberculosis Infections / Q000150:complications* / Q000382:microbiology
chemical_list: D007501:Iron