A Unique Presentation of Idiopathic Pulmonary Hemosiderosis

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Journal of Investigative Medicine





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Purpose of study Idiopathic Pulmonary Hemosiderosis (IPH) is a rare disease within the paediatric population. The purpose of this case report is to discuss a unique case of pulmonary hemosiderosis, and provide physicians with the necessary knowledge to appropriately identify and manage this condition in a timely fashion. Prompt management will to reduce complications and to identify a possible relationship with cardiac arrest. Methods used The patient’s medical charts and laboratory studies during the course of her hospital stay were reviewed for accuracy. Summary of results This is the case of a 5 month old male with bronchopulmonary dysplasia (BPD), who was born prematurely after 25 weeks of gestation, following which he had a 4 month NICU stay. He had been eating and growing well since discharge until he was seen at his pulmonologist’s office where he went into cardiac arrest. After resuscitation and intubation, he was transferred to our hospital. Vancomycin and ceftriaxone were started for suspected sepsis. Blood was noted to be coming up through the ET tube and a chest x-ray showed bilateral infiltrates that were suspicious for atelectasis. He underwent bronchoscopy the following day. Cytology of the bronchealveolar lavage sample showed hemosiderin-laden macrophages. He was diagnosed with idiopathic pulmonary hemosiderosis and started on prednisolone.The patient improved within the week and was extubated. Currently he is doing well after discharge and continues to be on prednisolone. Conclusions A high suspicion should be kept for IPH especially with children under the age of ten and/or who have a history of BPD and prematurity. It is still unclear to what the pathogenesis of IPH is, but recent case reports are showing that there might be an association between BPD and IPH. Patients typically present with the classic triad of hemoptysis, anaemia and non-specific opacities on chest imaging. As mentioned, the pathogenesis is unclear but immunological abnormalities, abnormal iron metabolism, or even environmental factors (second hand smoke) have been reported to play a role. Oral glucocorticoids are the mainstay of treatment for these patients and have been observed to reduce morbidity and mortality.


Medicine and Health Sciences



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