Rhabdomyolysis after Intravenous Ferric Gluconate: A Case Report
  • Mara Botti
    Department of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
  • Alberto Piperno
    Centre for Rare Diseases – Disorders of Iron Metabolism, ASST-Monza, San Gerardo Hospital, Monza, Italy
  • Annalia Cianflone
    Centre for Rare Diseases – Disorders of Iron Metabolism, ASST-Monza, San Gerardo Hospital, Monza, Italy; Medical Genetics, ASST-Monza, San Gerardo Hospital, Monza, Italy
  • Raffaella Mariani
    Centre for Rare Diseases – Disorders of Iron Metabolism, ASST-Monza, San Gerardo Hospital, Monza, Italy

Keywords

Ferric gluconate, rhabdomyolysis, non-transferrin-bound iron, adverse event

Abstract

Patients with severe iron deficiency, malabsorption or intolerance to oral iron are frequently treated with intravenous iron replacement. We report the case of a 42-year-old woman with non-erosive oligoarticular arthritis with antiparietal cell antibodies and iron deficiency anemia secondary to menorrhagia and unresponsive to oral iron preparations. She was treated with an intravenous infusion of ferric gluconate. After the first infusion of 125 mg (in 250 mL saline), she developed transient pain in her knee and wrist joints. When the dose was subsequently halved, the patient showed no adverse symptoms in the next four infusions and had normalized hemoglobin levels and iron indices. However, after a subsequent 125 mg ferric gluconate infusion she developed severe leg pain, muscular and joint stiffness, and functional impairment of her hands, right foot, and ankle. Laboratory tests showed a progressive increase in creatine kinase, transaminase, and C-reactive protein that normalized several days after the infusion. Although rhabdomyolysis is not reported among endovenous iron-induced adverse events, our findings suggest that intravenous iron infusions might have increased free iron generation promoting oxidative joint and muscular injury, which would explain the joint pain and stiffness, and rhabdomyolysis. Greater attention should be paid to the more frequent cases of myalgia occurring after iron infusion, which may underlie a rhabdomyolytic event requiring clinical observation.

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References

  • Drugs.com. Sodium ferric gluconate complex side effects [Internet]. Drugs.com c2000–2022. Available from: https://www.drugs.com/sfx/sodium-ferric-gluconate-complex-side-effects.html [accessed 7 March 2022].
  • Huerta-Alardín AL, Varon J, Marik PE. Bench-to-bedside review: rhabdomyolysis – an overview for clinicians. Crit Care 2005;9(2):158–169.
  • Foulkes WD, Sewry C, Calam J, Hodgson HJF. Rhabdomyolysis after intramuscular iron-dextran in malabsorption. Ann Rheum Dis 1991;50:184–186.
  • Garbowski MW, Bansal S, Porter JB, Mori C, Burckhardt S, Hider RC. Intravenous iron preparations transiently generate non-transferrin-bound iron from two proposed pathways. Haematologica 2021;106(11):2885–2896.
  • Ooi M, Hibbs S, Chen FE. The safety of modern intravenous iron infusions in patients with rheumatoid arthritis – a review of the literature. Hematology 2020;25(1):108–111.
  • Smallwood MJ, Nissim A, Knight AR, Whiteman M, Haigh R, Winyard PG. Oxidative stress in autoimmune rheumatic diseases. Free Radic Biol Med 2018;125:3–14.
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    Published: 2022-04-21
    Issue: 2022: Vol 9 No 4 (view)


    How to cite:
    1.
    Botti M, Piperno A, Cianflone A, Mariani R. Rhabdomyolysis after Intravenous Ferric Gluconate: A Case Report. EJCRIM 2022;9 doi:10.12890/2022_003325.