Neuroendocrine cell hyperplasia of infancy: an unusual cause of hypoxemia in children

Abstract

Background: Childhood interstitial lung disease (chILD) is a heterogeneous group of rare disorders characterized by abnormal imaging findings, impaired gas exchange; and is associated with substantial morbidity and mortality. Neuroendocrine cell hyperplasia (NEHI) is a unique sub-group, which is more prevalent in infants and children younger than 2 years of age, and typically manifests with chronic tachypnea, retractions, hypoxemia and failure to thrive. NEHI insidiously appears in the first year of life, subtly masquerading as one of the more common lung diseases of childhood. Therefore, the diagnosis of NEHI is challenging and requires a systematic approach.

Case presentation: We report a case of an infant, with a history of recurrent respiratory infections and wheezing, who presented with persistent hypoxemia (PaO2 88 mmHg) and chronic respiratory symptoms, that prompted an extensive diagnostic work up for chILD; eventually a diagnosis of NEHI was made.

Conclusion: NEHI is a rare chILD disorder presenting in the first 2 years of life with common but challenging key clinical features. Increased awareness among pediatricians and prompt recognition of the clinical presentation may enable timely diagnosis and improve disease management and prognosis.

Keywords: Ground-glass opacification; Hypoxemia; Interstitial lung disease in children; Neuroendocrine cell hyperplasia; Persistent tachypnea.

Fig. 1

Areas of interest: ground glass opacities in the medial portion of the upper lobes (a) and right middle lobe and lingula (b) with some areas of consolidation in the lingula

Fig. 2

Panoramic view of the lung parenchyma; alveolar structures are normal without any fibrosis; arrows show bronchi with hyperplastic neuroendocrine cells; staining with hematoxylin-eosin, Magnification 100× (a); immunostaining with bombesin, Magnification 100× (b)