pica and Uremia

Generalized or localized itch without primary skin manifestations may be the presenting symptom of serious internal diseases. Five characteristic cases of pruritus are discussed: Hodgkin's disease, primary sclerosing cholangitis, polycythemia vera, iron deficiency (with pica), and uremia. Other important causes must be considered; all forms of cholestasis, including primary biliary cirrhosis, drug-induced, pregnancy-related, and extrahepatic cholestasis; other hematologic and malignant disorders such as non-Hodgkin's lymphoma, leukemia, multiple myeloma, solid tumors, and myelodysplastic syndromes; metabolic and endocrine diseases, most notably diabetes mellitus, hyperthyroidism, hypothyroidism, and carcinoid syndrome; focal neurologic diseases such as brain tumors, cerebral infarctions and multiple sclerosis; adverse drug reactions without rash; infectious diseases, especially parasitic and HIV infections. A diagnostic laboratory screening for pruritus of undetermined origin is suggested.

Topics: Adult; Aged; Anemia, Iron-Deficiency; Cholangitis, Sclerosing; Diagnosis, Differential; Female; Hematologic Diseases; Hodgkin Disease; Humans; Liver Diseases; Male; Metabolic Diseases; Middle Aged; Pica; Polycythemia Vera; Pruritus; Uremia

Absolute or functional iron deficiency decreases the effectiveness of erythropoietin in patients undergoing hemodialysis. We describe a patient who developed pica associated to a ferritin level of 800 ng/ml during recombinant human erythropoietin treatment. The symptom subsided after supplementation with iron dextran. Therefore we recommend iron supplementation during the initial phase of treatment with erythropoietin until serum ferritin levels raise above 1000 ng/ml.

Topics: Adult; Anemia, Hypochromic; Erythropoietin; Ferritins; Glomerulonephritis, IGA; Humans; Immunologic Factors; Iron; Iron Deficiencies; Male; Pica; Protoporphyrins; Recombinant Proteins; Renal Dialysis; Transferrin; Uremia