A Case of Idiopathic Pulmonary Hemosiderosis Presenting With Signs and Symptoms Mimicking Hemolytic Anemia

Abstract

Idiopathic pulmonary hemosiderosis is primarily a disorder of childhood, which is characterized by hemoptysis, iron deficiency anemia, and diffuse parenchymal infiltrates on chest x-ray secondary to recurrent attacks of alveolar hemorrhage. It can be diagnosed by showing hemosiderin laden macrophages in bronchoalveolar lavage fluid after other specific causes of diffuse alveolar hemorrhage are definitely excluded. A 5-year-old male patient was admitted to our clinic with sudden-onset pallor during iron therapy given for anemia. While he was being investigated for clinical and laboratory signs mimicking hemolytic anemia, he developed cough and dyspnea. He had infiltrates on chest x-ray and scattered patchy infiltrates in both lungs on high-resolution computed tomography. Hemosiderin laden macrophages were identified in fasting gastric juice and bronchoalveolar lavage fluid. The patient was diagnosed with idiopathic pulmonary hemosiderosis and started corticosteroid therapy.

Cryobiopsy in the diagnosis of idiopathic pulmonary hemosiderosis: a case report

“…The clinical course usually suggests intra-alveolar bleeding with characteristic hemoptysis (19) observed in about 80% of patients (15,17,18). In cases similar to the present one, i.e., where there are lung interstitial alterations with a concurrent anemia, IPH should always be considered in the differential diagnosis even though hemoptysis might not be reported by the patient (14,17,(19)(20)(21)(22). The disease is usually found in children and young adults and thus lung interstitial alterations appear amid a healthy lung tissue.…”

Pulmonary hemorrhage in infancy: A 10‐year single‐center experience

“…Prior studies are difficult to compare due to heterogeneous populations. The wide variance in reported incidence, diagnosis, treatment, and outcome make understanding and management of this high‐risk population challenging …”

“…A wide variety of practices have developed around the diagnosis and treatment of idiopathic bleeding in infancy . The range of diagnostic modalities recommended has included chest radiographic studies, bronchoscopy, environmental evaluation, microbiology testing, echocardiogram, ophthalmic exam, skeletal survey, and lung biopsy . Treatments reported have included glucocorticoids and other immune modulatory medications, with varying doses and length of therapy .…”

“…13,14,16,[19][20][21][22] The range of diagnostic modalities recommended has included chest radiographic studies, bronchoscopy, environmental evaluation, microbiology testing, echocardiogram, ophthalmic exam, skeletal survey, and lung biopsy. 8,23,24 Treatments reported have included glucocorticoids and other immune modulatory medications, with varying doses and length of therapy. 3,8,19,20,25 Prior studies are difficult to compare due to heterogeneous populations.…”

“…The wide variance in reported incidence, diagnosis, treatment, and outcome make understanding and management of this high-risk population challenging. 1,4,8,[13][14][15][16][19][20][21]24,26,27 In order to better understand the clinical context of infants presenting with bleeding from the respiratory tract, the frequencies of different diagnoses, and the number of idiopathic cases remaining after diagnostic evaluation, we undertook this retrospective study of pulmonary hemorrhage in infancy at a large, single center over a 10-year period at Boston Children's Hospital. We then analyzed outcomes and treatment for the patients identified as AIPHI.…”