Pulmonary Hemosiderosis in Association with Celiac Disease

Abstract

A 15-year-old male had a history of increasing dyspnea on exertion, cough, sputum production, fever, weakness, hemoptysis, and diarrhea. Chest radiography demonstrated bilateral alveolar consolidation. Bronchoalveolar lavage fluid analysis revealed extensive hemosiderin-laden alveolar macrophages. On the basis of iron deficiency anemia, diarrhea, raised antigliadin and antiendomysial antibodies, widespread villous atrophy, and crypt hyperplasia on intestinal biopsy, celiac disease was diagnosed. After treatment with a gluten-free diet, all his clinical symptoms and radiographic findings improved within two weeks.

Pulmonary haemosiderosis in a 13-year-old girl with coeliac disease after 3 months on a gluten-free diet: case report and review of the literature

“…Some have reported improvement on a gluten-free diet alone, others have reported improvement on systemic corticosteroids. 1,2,5,9,[11][12][13] Our patient was already on a gluten-free diet and had negative CD serology before IPH presented. Within 5 days she showed a dramatic radiological and clinical response to oral corticosteroids (Fig.…”

“…9,10 The pathogenic mechanism of this association is still unknown but, interestingly, most reported cases of CD and PH developed the latter while they had active CD and were on a glutencontaining diet. 1,2,[9][10][11] Most of them had a high titre of anti-endomesial and antigliadin antibodies at the time of pulmonary manifestations and some improved on a gluten-free diet alone. 1,[9][10][11] This is in favour of cross-reactivity between antireticulin antibodies and alveolar basal membrane antigens.…”

“…1,2,[9][10][11] Most of them had a high titre of anti-endomesial and antigliadin antibodies at the time of pulmonary manifestations and some improved on a gluten-free diet alone. 1,[9][10][11] This is in favour of cross-reactivity between antireticulin antibodies and alveolar basal membrane antigens. [6][7][8] Contrary to this hypothesis, our case had controlled CD and negative anti-endomesial and antigliadin antibodies at the time of PH.…”

“…1 All of the children previously reported with this association presented initially with IPH and had concurrent CD or developed it later. 2,3 In most of them, the diagnosis of CD was suspected either because of relevant gastro-intestinal symptoms [2][3][4] or because of severe anaemia.…”

Hemorragia pulmonar asociada a enfermedad celíaca

“…6 En ambos pacientes de esta serie se destaca la ausencia de síntomas gastrointestinales al momento de la consulta, pero el aumento de Ac antitransglutaminasa y antiendomisio, solicitados dentro del plan de estudios de pacientes con hemorragia pulmonar, permitieron sospechar el diagnóstico de enfermedad celíaca, el cual se confirmó por biopsia intestinal. 7 Debe destacarse, no obstante, que un 5-10% de los pacientes con enfermedad celíaca presentan asociada una deficiencia selectiva de IgA. En ellos la serología carece de utilidad y solo la biopsia de intestino permite confirmar el diagnóstico.…”