Anaemia and respiratory failure in a child: can it be idiopathic pulmonary haemosiderosis?

Abstract

We present an 8-year-old male child admitted with cough and high-grade fever for 7 days and respiratory difficulty for 2 days. There was a history of blood transfusion at 2 years of age during a respiratory illness. The child was anaemic, tachycardic, tachypnoeic and hypoxic at presentation. Chest examination revealed equal air entry with fine crackles bilaterally. Blood reports were suggestive of anaemia (haemoglobin 6.5 g/dL), leucocytosis and high C reactive protein levels. Chest radiograph revealed bilateral air space opacities involving diffuse lung fields, right more than left. Relevant microbiological workup was negative. Based on the clinical scenario and investigations, a provisional diagnosis of pulmonary haemosiderosis was kept. The patient was started on intravenous pulse methylprednisolone. Fibre-optic bronchoscopy was done following recovery from the acute event. Bronchoalveolar lavage demonstrated a significant number of haemosiderin-laden macrophages confirming pulmonary haemosiderosis.

Keywords: Paediatrics; Respiratory medicine.

Figure 1

(A) Chest radiograph showing bilateral diffuse opacities. (B) CT scan showing bilateral ground glass opacities. (C) Normal chest radiograph at discharge.

Figure 2

(A) Bronchoalveolar lavage showing ciliated columnar bronchial cells along with haemosiderin-laden macrophages (arrow). (B) Prussian blue stain positive in the haemosiderin-laden macrophages.