Diffuse pulmonary small nodular and patchy infiltrates on chest X-ray with hemoptysis: TB or not TB?-a call for scale up of respiratory medicine services in African TB high burden countries: a case of idiopathic pulmonary hemosiderosis

Abstract

Tuberculosis is still one of the most common respiratory diseases in Africa and worldwide and miliary tuberculosis is a regular manifestation of it. Idiopathic pulmonary hemosiderosis is a rare disease entity, presenting in children as well as adults. It is characterized by the triad of recurrent episodes of alveolar hemorrhage, presenting as hemoptysis, iron deficiency anemia and bilateral pulmonary infiltrates seen on chest X-ray. These symptoms and signs can easily be confused for other diseases i.e. miliary tuberculosis, delaying appropriate management. The etiology of idiopathic pulmonary hemosiderosis remains unclear. Diagnosis is established by lung biopsy, revealing hemosiderin laden macrophages in the alveoli. Treatment during an acute episode includes corticosteroids and/or immunosuppressive therapy, as well as supportive measures. Long-term follow-up is essential.

Keywords: Pulmonary tuberculosis; idiopathic pulmonary haemo-siderosis; respiratory services.

Figure 1

Postero-anterior chest X-rays showing bilateral diffuse nodular infiltrates, similar to miliary TB

Figure 2

Lateral chest X-rays showing bilateral diffuse nodular infiltrates, similar to miliary TB

Figure 3

HR-CT scan showing diffuse ground glass opacities indicative of alveolar haemorrhage and thickened interlobar septae

Figure 4

HR-CT scan showing diffuse ground glass opacities indicative of alveolar haemorrhage and thickened interlobar septae, indicating extent of disease

Figure 5

Bilateral alveolar lavage showing diffuse macroscopic haemorrhage

Figure 6

Histology of trans-bronchial biopsy demonstrating iron laden macrophages in silver stain

Figure 7

Histology of trans-bronchial biopsy demonstrating iron laden macrophages H&E stain