Hepcidin and Ferritin Levels in Fever of Unknown Origin: Is There a New Biomarker?

Background and objectives: Significantly elevated serum ferritin levels are associated with both iron overload and some inflammatory conditions. Hepcidin is a protein that interferes with iron absorption in inflammatory states and acts as an acute-phase reactant. Materials and methods: Here we report the case a 33-year-old patient who presented with high fever, skin lesions and arthralgia lasting for 2 weeks. His ferritin level was 13,800 µg/l and his hepcidin level was 61 ng/dl. Results: The final diagnosis was adult onset Still's disease. The condition evolved satisfactorily with steroid treatment, but after several weeks the patient presented with an unexpected recurrence. Conclusions: Hepcidin is a good inflammatory marker that could be useful in the differential diagnosis of hyperferritinaemia.

Giant Cell Arteritis Presenting with Bilateral Subdural Haematomas of Arterial Origin

Giant cell arteritis or temporal arteritis is an inflammatory condition affecting medium to large sized vessels, particularly the cranial arteries. A 76-year-old man with no significant past medical history presented to the emergency department with a 3-week history of diffuse headaches associated with fever, loss of appetite, weight loss and general malaise. A CT scan of the brain showed bilateral shallow chronic low density subdural haematomas. A complete laboratory panel was unremarkable except for a raised erythrocyte sedimentation rate and elevated C-reactive protein. A transthoracic echocardiogram and CT scan of the body were unremarkable. MRI of the brain confirmed bilateral old subdural collections and showed marked vessel wall enhancement in the frontal branches of the left superficial temporal artery. A left temporal artery biopsy confirmed giant cell temporal arteritis. We speculate that a vasculitic process in the small subdural arteries may have contributed to our patient’s spontaneous subdural haematomas.