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Kono M, Oshima Y, Katsumata M, Hirama R, Takeda K, Mochizuka Y, Tsutsumi A, Miwa H, Miki Y, Hashimoto D, Otsuki Y, Suda T, Nakamura H. An Adult Case of Idiopathic Pulmonary Hemosiderosis Associated with Pulmonary Fibrosis and Emphysematous Change. Intern Med 2024; 63:119-124. [PMID: 37225487 PMCID: PMC10824645 DOI: 10.2169/internalmedicine.1663-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Accepted: 04/11/2023] [Indexed: 05/26/2023] Open
Abstract
A 48-year-old woman was admitted to our hospital with acute respiratory failure. Chest computed tomography showed ground-glass opacity and patchy emphysematous lesions in both lungs. Corticosteroid therapy was effective; however, the disease worsened with the tapering of corticosteroids. Bronchoalveolar lavage revealed hemosiderin-laden macrophages, and video-assisted thoracic surgery showed diffuse interstitial fibrosis with diffuse alveolar hemorrhage (DAH). There was no evidence of vasculitis nor autoimmune diseases. This patient was diagnosed with idiopathic pulmonary hemosiderosis (IPH) that progressed to end-stage pulmonary fibrosis despite treatment. Autopsy demonstrated DAH with pulmonary fibrosis and emphysematous change, suggesting IPH-related pulmonary lesions.
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Affiliation(s)
- Masato Kono
- Department of Respiratory Medicine, Seirei Hamamatsu General Hospital, Japan
| | - Yuiko Oshima
- Department of Respiratory Medicine, Seirei Hamamatsu General Hospital, Japan
| | - Megumi Katsumata
- Department of Respiratory Medicine, Seirei Hamamatsu General Hospital, Japan
| | - Ryutaro Hirama
- Department of Respiratory Medicine, Seirei Hamamatsu General Hospital, Japan
| | - Kenichiro Takeda
- Department of Respiratory Medicine, Seirei Hamamatsu General Hospital, Japan
| | - Yasutaka Mochizuka
- Department of Respiratory Medicine, Seirei Hamamatsu General Hospital, Japan
| | - Akari Tsutsumi
- Department of Respiratory Medicine, Seirei Hamamatsu General Hospital, Japan
| | - Hideki Miwa
- Department of Respiratory Medicine, Seirei Hamamatsu General Hospital, Japan
| | - Yoshihiro Miki
- Department of Respiratory Medicine, Seirei Hamamatsu General Hospital, Japan
| | - Dai Hashimoto
- Department of Respiratory Medicine, Seirei Hamamatsu General Hospital, Japan
| | - Yoshiro Otsuki
- Department of Pathology, Seirei Hamamatsu General Hospital, Japan
| | - Takafumi Suda
- Second Division, Department of Internal Medicine, Hamamatsu University School of Medicine, Japan
| | - Hidenori Nakamura
- Department of Respiratory Medicine, Seirei Hamamatsu General Hospital, Japan
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Khan M, Gowa MA, Jamal G, Nawaz H, Aqeel Abidi SM. Idiopathic Pulmonary Haemosiderosis: An Unusual Case Of Anaemia With Pulmonary Involvement. J PAK MED ASSOC 2023; 73:1729-1731. [PMID: 37697773 DOI: 10.47391/jpma.7323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/13/2023]
Abstract
Idiopathic pulmonary haemosiderosis is a rare disorder, with recurrent life-threatening alveolar haemorrhages and chronic lung parenchymal changes. It is associated with a triad of haemoptysis, iron deficiency anaemia, and diffuse pulmonary infiltrates. Although most cases are idiopathic, secondary haemosiderosis linked to known diseases has also been observed. Most of the cases remain undiagnosed because the disease is very low on the list of differentials. There is no specified age for the disease. The present study reports on an adolescent female patient who presented with microcytic anaemia and bilateral lung infiltrates to the National Institute of Child Health (NICH), Karachi, a tertiary care hospital. She was diagnosed with Idiopathic pulmonary haemosiderosis after ruling out other possibilities.
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Affiliation(s)
- Momina Khan
- Department of Paediatric Intensive Care Unit, National Institute of Child Health, Karachi, Pakistan
| | - Murtaza Ali Gowa
- Department of Paediatric Intensive Care Unit, National Institute of Child Health, Karachi, Pakistan
| | - Ghazala Jamal
- Department of Paediatric Intensive Care Unit, National Institute of Child Health, Karachi, Pakistan
| | - Hira Nawaz
- Department of Paediatric Intensive Care Unit, National Institute of Child Health, Karachi, Pakistan
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Renard D, Laurent-Chabalier S, Leonte A, Hackius M, Parvu T, Wacongne A, Thouvenot E. Cerebellar Superficial Siderosis in Cerebral Amyloid Angiopathy on 1.5T T2*-Weighted Imaging. Cerebrovasc Dis 2023; 52:706-710. [PMID: 36878206 DOI: 10.1159/000528384] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Accepted: 11/21/2022] [Indexed: 03/08/2023] Open
Abstract
BACKGROUND Cerebellar superficial siderosis (SS) has been recently reported to be present in about 10% of both hereditary and sporadic cerebral amyloid angiopathy (CAA) on 3T MRI using primarily susceptibility-weighted imaging. OBJECTIVES Our aim was to assess cerebellar SS in sporadic CAA patients using 1.5T T2*-weighted MRI and to evaluate possible underlying mechanisms. METHOD We retrospectively screened MRI scans of sporadic probable CAA patients initially presenting with intracerebral hemorrhage-, acute subarachnoid hemorrhage- or cortical SS-related symptoms between September 2009 and January 2022 registered in our stroke database. Patients with familial CAA were excluded. On 1.5T T2*-weighted MRI, cerebellar SS (including kappa statistics for interobserver agreement) was assessed together with typical CAA hemorrhagic features and with the presence of supratentorial macrobleed and cortical SS adjacent to the tentorium cerebelli (TC) and TC hemosiderosis. RESULTS We screened 151 patients and finally included 111 CAA patients (median age 77) with cerebellar SS observed in 6 (5%) patients. Cerebellar SS presence was associated with a higher number of supratentorial macrobleeds (median n = 3 vs. n = 1, p = 0.0012), presence of supratentorial macrobleed adjacent to the TC (p = 0.002), and TC hemosiderosis (p = 0.005). CONCLUSIONS Cerebellar SS in CAA patients can be identified on 1.5T T2*-weighted imaging. Associated MRI characteristics suggest contamination from supratentorial macrobleeds.
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Affiliation(s)
- Dimitri Renard
- Department of Neurology, CHU Nîmes, University Montpellier, Nîmes, France
| | - Sabine Laurent-Chabalier
- Department of Biostatistics, Clinical Epidemiology, Public Health, and Innovation in Methodology, CHU Nîmes, University Montpellier, Nîmes, France
| | - Adelina Leonte
- Department of Neurology, CHU Nîmes, University Montpellier, Nîmes, France
| | - Marc Hackius
- Department of Neurology, CHU Nîmes, University Montpellier, Nîmes, France
| | - Teodora Parvu
- Department of Neurology, CHU Nîmes, University Montpellier, Nîmes, France
| | - Anne Wacongne
- Department of Neurology, CHU Nîmes, University Montpellier, Nîmes, France
| | - Eric Thouvenot
- Department of Neurology, CHU Nîmes, University Montpellier, Nîmes, France
- Institut de Génomique Fonctionnelle, CNRS UMR5203, INSERM 1191, University Montpellier, Montpellier, France
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Saha BK, Aiman A, Chong WH, Saha S, Song J, Bonnier A. Updates in idiopathic pulmonary hemosiderosis in 2022: A state of the art review. Pediatr Pulmonol 2023; 58:382-391. [PMID: 36324124 DOI: 10.1002/ppul.26230] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Revised: 09/14/2022] [Accepted: 11/02/2022] [Indexed: 11/06/2022]
Abstract
This manuscript reports the recent advances in idiopathic pulmonary hemosiderosis (IPH), a rare cause of diffuse alveolar hemorrhage in children and adults. This narrative review of the literature summarizes different aspects of IPH, including proposed pathogenesis, patient demographics, clinical and radiological characteristics, treatment, and prognosis. Additionally, the association between Celiac Disease (CD) and IPH is carefully evaluated. IPH is a frequently misdiagnosed disease. The delay in the diagnosis of IPH is often significant but fortunately, appears to have decreased in recent years. IPH in adults and children have distinct demographic preferences. The autoantibodies are common in IPH but with a definite difference between the adult and pediatric populations. The definitive diagnosis of IPH requires lung biopsy and careful exclusion of all competing diagnoses, even with lung biopsy showing bland pulmonary hemorrhage. The presence of nonspecific inflammatory cells or lymphoid aggregates may suggest a secondary immunologic phenomenon and needs careful evaluation and follow-up. A substantial number of patients suffer from coexisting CD, also known as Lane-Hamilton syndrome (LHS), and all patients with IPH need to be evaluated for LHS by serology. Although strict gluten free diet can manage the majority of patients with LHS, other patients generally require immunosuppressive therapy. The corticosteroids are the backbone of IPH therapy. Recently utilized experimental treatment options include mesenchymal stem cell transplant, liposteroid and bronchial artery embolization. The immunosuppression should be adjusted to achieve optimal disease control. Patients may progress to end-stage lung disease despite all measures, and lung transplantation may be the only viable option.
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Affiliation(s)
- Biplab K Saha
- Department of Pulmonary, Critical Care and Sleep Medicine, University of Florida, Gainesville, Florida, USA
| | - Alexis Aiman
- New York Institute of Technology College of Osteopathic Medicine at Arkansas State University, Arkansas, USA
| | - Woon Hean Chong
- Department of Intensive Care Medicine, Ng Teng Fong General Hospital, National University Health System, Singapore City, Singapore
| | - Santu Saha
- Department of Internal Medicine, Saha Clinic, Narail, Bangladesh
| | - Jini Song
- New York Institute of Technology College of Osteopathic Medicine at Arkansas State University, Arkansas, USA
| | - Alyssa Bonnier
- Department of Critical Care Nursing, Goldfarb School of Nursing, Barnes Jewish College, St. Louis, Missouri, USA
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Saha BK, Bonnier A, Saha S, Saha BN, Shkolnik B. Adult patients with idiopathic pulmonary hemosiderosis: a comprehensive review of the literature. Clin Rheumatol 2022; 41:1627-1640. [PMID: 35179664 DOI: 10.1007/s10067-022-06104-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2022] [Revised: 02/01/2022] [Accepted: 02/15/2022] [Indexed: 12/24/2022]
Abstract
Idiopathic pulmonary hemosiderosis (IPH) is a rare disease without a known incidence or prevalence in adults. Our knowledge of this entity is limited as there is no prospective or retrospective study with a reasonable number of patients. The objective is to describe the demographics, clinical manifestations, diagnosis, treatment, and prognosis of adult patients with IPH. The Medline and Embase databases were searched from inception to 2021 with appropriate search formulas to identify relevant articles following strict inclusion and exclusion criteria. Statistical analyses were performed for the entire cohort and prespecified subgroups. A total of 84 patients were identified. The majority of patients were males 54/84 (64.3%). The median age was 27 years. The manifesting symptoms were present in the following frequencies: anemia 76/83 (91.6%), dyspnea 71/83 (85.5%), hemoptysis 70/84 (83.3%), cough 22/84 (26.2%), and chest pain 9/84 (10.7%). The classic triad was present in 61/84 (79%) patients. The mean hemoglobin during the initial presentation was 8.4 gm/dL. A total of 16/57 (19.5%) tested positive for autoantibodies. The median delay in the diagnosis of IPH was 1.02 years. Immunosuppressive therapy was prescribed in 49/79 (62%) patients, and recurrence occurred in more than half of the patients 36/66 (54.5%). A total of 63/79 (79.7%) patients were alive during the final follow-up. IPH is more common in young adults with a male predominance. A high index of suspicion is necessary to attain an early diagnosis and possibly reduce the short-term mortality of nearly 20% and long-term complications.
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Affiliation(s)
- Biplab K Saha
- Department of Pulmonary and Critical Care Medicine, Ozarks Medical Center, 1100 Kentucky Avenue, West Plains, MO, 65775, USA.
| | - Alyssa Bonnier
- Department of Critical Care Nursing, Goldfarb School of Nursing, Barnes Jewish College, St. Louis, MO, USA
| | - Santu Saha
- Department of Medicine, Saha Clinic, Narail, Bangladesh
| | | | - Boris Shkolnik
- Department of Pulmonary and Critical Care Medicine, Albany Medical Center, Albany, NY, USA
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Saha BK, Saha S, Bonnier A, Saha BN. Association between idiopathic pulmonary hemosiderosis and celiac disease in pediatric patients: A scoping review of the literature over the past 50 years. Pediatr Pulmonol 2022; 57:1127-1144. [PMID: 35088581 DOI: 10.1002/ppul.25847] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Revised: 01/17/2022] [Accepted: 01/24/2022] [Indexed: 11/05/2022]
Abstract
INTRODUCTION Idiopathic pulmonary hemosiderosis (IPH) is a rare cause of diffuse alveolar hemorrhage, the mechanism of which is currently unknown. Nearly one-third of pediatric patients with IPH test positive for Celiac disease (CD) serology. Several hypothetical mechanisms have been proposed to unify the coexistence of these two entities, also referred to as Lane-Hamilton syndrome (LHS). METHOD This manuscript is a scoping review of the medical literature. Medline, Embase, and PubMed Central databases were searched between 1971 and 2021 with appropriate search words to identify all cases of pediatric LHS. RESULTS A total of 20 manuscripts with 23 pediatric patients with LHS were identified. The mean age was 11 years, and 13/23 (56.5%) of the children were boys. Hemoptysis was present in 57% of patients during diagnosis. Bronchoscopy with bronchoalveolar lavage demonstrating hemosiderin laden macrophages was the primary mode of diagnostic confirmation. Only three patients underwent lung biopsy. Any significant GI symptom was reported in a minority of patients (22%). Iron deficiency anemia on presentation was described in 83% of children. The majority of patients were malnourished. Serology for CD was positive in all patients, as was the histopathologic analysis of the small bowel biopsy. No patients had any other autoantibody positivity. The introduction of gluten free diet (GFD) was associated with a positive response in 20/23 patients. CONCLUSION All pediatric patients with IPH should undergo screening for CD. Low serum ferritin in patients with IPH could be suggestive of coexisting CD. Strict GFD should be tried as the initial therapy.
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Affiliation(s)
- Biplab K Saha
- Department of Pulmonary and Critical Care Medicine, Ozarks Medical Center, West Plains, Missouri, USA
| | - Santu Saha
- Department of Internal Medicine, Bangladesh Medical College, Dhaka, Bangladesh
| | - Alyssa Bonnier
- Department of Critical Care Nursing, Goldfarb School of Nursing, Barnes Jewish College, St. Louis, Missouri, USA
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Mooney EE, Crotty E. High-Grade Fetal Vascular Malperfusion Is Associated With Diffuse Chorionic Hemosiderosis. Pediatr Dev Pathol 2022; 25:292-295. [PMID: 34962169 DOI: 10.1177/10935266211064694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
INTRODUCTION Diffuse chorionic hemosiderosis (DCH) is an abnormality of the placental membranes characterized by the deposition of iron pigment. It is usually secondary to recurrent venous bleeding in early pregnancy. In many papers, it is associated with pre-term delivery. Fetal vascular malperfusion (FVM) is an abnormality of the feto-placental circulation that may be seen at any stage of gestation, but most often in the third trimester. It may be graded as low grade (LGFVM) or high grade (HGFVM). No link has been identified in the placental literature between DCH and FVM, but we have noted the 2 co-existing in placentas submitted for analysis. This study explored a possible association of these 2 entities. METHODS Laboratory records were searched for singleton cases coded as DCH based on diagnosis on H&E stain over a 6-year period. Of 4478 placentas reported, 66 cases were coded as DCH (1.5%). These were classified as showing HGFVM, LGFVM, or no FVM. Controls (n = 132) were gestational age-matched cases without DCH. Cord length, coiling, insertion, or other abnormalities were noted. Membranes were classified as normal or circumvallate. Results were analyzed using Graphpad. RESULTS Gestation ranged between 16 and 41 weeks gestation. 14/66 (21%) cases of DCH showed HGFVM and 2/66 (3%) showed LGFVM. 16/132 (12%) controls showed HGFVM and 21/132 (15.9%) had LGFVM. Where FVM is present, high-grade FVM is significantly associated with DCH versus controls (P < .0031 Fischer's Test). DISCUSSION HGFVM occurs significantly more often in placentas with DCH than in controls. Both FVM and DCH are associated with adverse perinatal outcomes, and a possible relationship between the 2 remains to be clarified.
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Affiliation(s)
- Eoghan E Mooney
- Department of Pathology and Laboratory Medicine, 58003National Maternity Hospital, Dublin, Ireland
| | - Emma Crotty
- Department of Pathology and Laboratory Medicine, 58003National Maternity Hospital, Dublin, Ireland
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Fukushima K, Hara A, Kido T, Ono R, Zaizen Y, Yamane Y, Ishimoto H, Sakamoto N, Fukuoka J, Mukae H. Recurrence of idiopathic pulmonary hemosiderosis in adults with childhood onset: A case report and literature review. Respir Investig 2022; 60:438-442. [PMID: 35307363 DOI: 10.1016/j.resinv.2022.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Revised: 01/27/2022] [Accepted: 02/18/2022] [Indexed: 10/18/2022]
Abstract
We describe a rare case of a 20-year-old Japanese man with idiopathic pulmonary hemosiderosis (IPH) recurrence in adults with childhood onset (racIPH). IPH commonly occurs in children, and data regarding racIPH are lacking. A review of the literature showed that only five cases of racIPH have been reported (including the present case) and that racIPH shows features that are intermediate between childhood- and adult-onset IPH with respect to age and a lower frequency of smoking history. We also found that the degree of anemia was usually not severe, and a favorable response to corticosteroid therapy is expected in racIPH.
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Affiliation(s)
- Koki Fukushima
- Department of Respiratory Medicine, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki City, Nagasaki, 852-8501, Japan
| | - Atsuko Hara
- Department of Respiratory Medicine, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki City, Nagasaki, 852-8501, Japan
| | - Takashi Kido
- Department of Respiratory Medicine, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki City, Nagasaki, 852-8501, Japan.
| | - Rika Ono
- Department of Respiratory Medicine, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki City, Nagasaki, 852-8501, Japan
| | - Yoshiaki Zaizen
- Department of Pathology, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki City, Nagasaki, 852-8520, Japan
| | - Yusuke Yamane
- Department of Surgical Oncology, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki City, Nagasaki, 852-8520, Japan
| | - Hiroshi Ishimoto
- Department of Respiratory Medicine, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki City, Nagasaki, 852-8501, Japan
| | - Noriho Sakamoto
- Department of Respiratory Medicine, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki City, Nagasaki, 852-8501, Japan
| | - Junya Fukuoka
- Department of Pathology, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki City, Nagasaki, 852-8520, Japan
| | - Hiroshi Mukae
- Department of Respiratory Medicine, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki City, Nagasaki, 852-8501, Japan
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Nishikado M, Awaguni H, Shinozuka J, Okumura K, Imashuku S. Puzzling (IRIDA-Like and Hemolytic) Anemia in a Child With Idiopathic Pulmonary Hemosiderosis. J Pediatr Hematol Oncol 2022; 44:191-193. [PMID: 34966096 DOI: 10.1097/mph.0000000000002385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Accepted: 11/22/2021] [Indexed: 11/25/2022]
Abstract
Before the diagnosis of idiopathic pulmonary hemosiderosis (IPH), unexplained or puzzling anemia may precede and delay in the diagnosis of pediatric IPH is common. A 5.8 years old female child initiated with iron-refractory iron deficiency anemia-like iron deficiency and hemolytic anemia and at 6.8 years of age IPH was materialized, when the patient showed the triad signs of IPH with hemosiderin-laden alveolar macrophages in gastric aspirate. Although time to the diagnosis was previously reported to be ranged from 16 to 30 months, in our case it took 12 months from the initial anemia to IPH diagnosis.
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Affiliation(s)
| | | | | | | | - Shinsaku Imashuku
- Departments of Pediatrics
- Laboratory Medicine, Uji-Tokushukai Medical Center, Uji, Kyoto, Japan
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Saha BK, Bonnier A, Chenna P, Milman NT. Prevalence of autoantibodies in pediatric patients with idiopathic pulmonary hemosiderosis: a scoping review of the literature in the period 1980-2021. Clin Rheumatol 2022; 41:977-990. [PMID: 35067768 DOI: 10.1007/s10067-021-06029-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Revised: 12/04/2021] [Accepted: 12/18/2021] [Indexed: 11/03/2022]
Abstract
Idiopathic pulmonary hemosiderosis (IPH) is a rare disease of unknown etiology. Due to the frequent findings of autoimmune antibodies - autoantibodies, immunologic causation of the diffuse alveolar hemorrhage in IPH has been proposed, to assess the prevalence/frequency and type of autoantibodies in pediatric patients with IPH. In addition, the patient demographics, diagnostic modalities used to diagnose IPH, treatment, and outcomes were also evaluated. Scoping review: The PubMed, Medline, and Embase databases were searched with appropriate MeSH terms to identify relevant papers consistent with the defined inclusion criteria. Thirteen observational studies comprising a total of 352 pediatric patients were included in this review. The majority of subjects were girls 217 out of 352 (61.6%). The mean and median ages of patients ranged from 3.1-6.5 years to 2.3-7 years, respectively. In the 10 studies that specified the number of patients in their cohorts with either at least one positive autoantibody or no antibody, the overall prevalence of autoantibodies was 76 out of 288 patients (26.4%). The prevalence of specific antibodies was as follows: ANA, 20.3%; ANCA, 17%; anti-dsDNA, 9.1%; RF, 12%; anti-SMA, 23.2%; and celiac antibodies, 25.9%. Cow's milk protein allergy was present in 16.2% of the children. The significance of an association between IPH and the presence of autoantibodies has not been clarified. The autoantibodies could be suggestive of an overall immune dysregulation rather than causation. However, limited evidence based on a single study suggests that the presence of ANA may be associated with a higher risk of recurrence and worse outcomes. Further research, including prospective studies, will be crucial to explore a possible genetic linkage between vasculitides, systemic rheumatologic diseases, and IPH.
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Affiliation(s)
- Biplab K Saha
- Division of Pulmonary and Critical Care Medicine, Ozarks Medical Center, 1100 Kentucky Avenue, West Plains, MO, 65775, USA.
| | - Alyssa Bonnier
- Goldfarb School of Nursing at Barnes-Jewish College, Saint Louis, MO, USA
| | - Praveen Chenna
- Division of Pulmonary and Critical Care Medicine, Washington University School of Medicine, Saint Louis, MO, USA
| | - Nils T Milman
- Department of Clinical Biochemistry, Næstved Hospital, University College Zealand, 4700, Næstved, Denmark
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Saha BK, Milman NT. Liposteroid Therapy for Idiopathic Pulmonary Hemosiderosis: A Scoping Review of the Literature. Prague Med Rep 2022; 123:65-81. [PMID: 35507939 DOI: 10.14712/23362936.2022.7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
Idiopathic pulmonary hemosiderosis (IPH) is a rare cause of diffuse alveolar hemorrhage (DAH). Glucocorticosteroids (CS) represent the first line therapy for IPH. Although most patients respond to CS, steroid refractoriness is seen in an appreciable minority of patients. This paper reviews and evaluates the efficacy and safety profile of liposomal dexamethasone 21-palmitate (liposteroid) for the treatment of IPH. Medline, Embase and Web of Science biomedical databases were searched between 1980 and 2020 to identify papers describing patients with IPH, who were treated with liposteroid. A total of five articles were identified. Four in the form of case reports and one as a case series. A total of 12 pediatric patients (5 boys, 7 girls) were identified, with a median age of 2.3 years (range 0.5-8.6). Liposteroid therapy in intravenous doses ranging 0.06-0.1 mg/kg body weight appeared to be effective for both remission induction therapy, and maintenance therapy. There was no mortality among patients treated with liposteroid, either in the acute phase or during follow-up. The majority of patients for whom long-term follow-up data were available, were cured or in disease remission. No acute adverse events were reported, and long-term side effects were minimal and tolerable. Liposteroid represents a potential alternative or supplement to conventional CS therapy, as it appears to be more efficacious and associated with fewer side effects. Larger prospective, controlled trials are necessary to be able to define more precisely the therapeutic role of liposteroid in IPH.
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Affiliation(s)
- Biplab K Saha
- Division of Pulmonary and Critical Care Medicine, Ozarks Medical Center, West Plains, USA.
| | - Nils T Milman
- Department of Clinical Biochemistry, Næstved Hospital, University College Zealand, Næstved, Denmark
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Abstract
BACKGROUND Idiopathic pulmonary hemosiderosis (IPH) encompasses a rare and agnogenic group of diffuse alveolar capillary hemorrhagic diseases. Corticosteroid treatment is the globally preferred therapeutic strategy for IPH; however, it can cause immunodeficiency. Nocardia infection often occurs in immunocompromised patients and primarily involves the pleura and lungs. Herein, we describe a case of pediatric pulmonary Nocardia infection after the corticosteroid treatment of IPH. CASE PRESENTATION A 7-year-old girl presented with chief complaints of pale complexion persisting for 1 year and a cough for 20 days. Abundant hemosiderin-laden macrophages were detected in the gastric juice, which supported the diagnosis of IPH. Uninterrupted doses of corticosteroids were administered during the last hospitalization. After nearly 2 months of corticosteroids therapy, the patient began to cough and produce a purulent sputum. Next-generation sequencing of the bronchoalveolar lavage fluid revealed Nocardia abscessus (N. abscessus) DNA. Linezolid was administered with good response, and the patient was discharged after 18 days of hospitalization. Her symptoms and pulmonary lesions had recovered, and the IPH appeared to be well-controlled with low dose of corticosteroids in follow-up. CONCLUSIONS Nocardia infection should be considered in the differential diagnoses for IPH patients receiving corticosteroid therapy, especially in patients with poor response to conventional empirical antibiotic therapy. Next-generation sequencing of bronchoalveolar lavage fluid may be used to quickly identify the Nocardia. Sulfonamides or linezolid are effective for pediatric pulmonary Nocardia infection.
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Affiliation(s)
- Lu Qin
- Department of Pulmonology, Children's Hospital of Zhejiang University School of Medicine, 3333 Binsheng Road, Hangzhou, 310051, China
| | - Fei-Zhou Zhang
- Department of Pulmonology, Children's Hospital of Zhejiang University School of Medicine, 3333 Binsheng Road, Hangzhou, 310051, China
| | - Tong-Yu Yang
- Department of Pulmonology, Children's Hospital of Zhejiang University School of Medicine, 3333 Binsheng Road, Hangzhou, 310051, China
| | - Xiao-Fen Tao
- Department of Pulmonology, Children's Hospital of Zhejiang University School of Medicine, 3333 Binsheng Road, Hangzhou, 310051, China
| | - Lan-Fang Tang
- Department of Pulmonology, Children's Hospital of Zhejiang University School of Medicine, 3333 Binsheng Road, Hangzhou, 310051, China.
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14
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Walsh L, McCarthy C, Henry M. Autoimmune pulmonary alveolar proteinosis and idiopathic pulmonary haemosiderosis: a dual pathology. BMJ Case Rep 2021; 14:e241048. [PMID: 33811096 PMCID: PMC8023637 DOI: 10.1136/bcr-2020-241048] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/16/2021] [Indexed: 02/04/2023] Open
Abstract
Pulmonary alveolar proteinosis (PAP) is a rare pulmonary condition which leads to excessive accumulation of proteinaceous material within the alveoli. Idiopathic pulmonary haemosiderosis (IPH) is another orphan lung disease and results in recurrent alveolar haemorrhage. This case study describes a case of these two rare pathologies occurring together. A man in his 50s presented with a 6-week history of haemoptysis and worsening dyspnoea. A CT scan of the thorax showed multifocal, bilateral ground glass opacification with a wide differential diagnosis. Full autoantibody screen including myositis panel and coeliac screen were negative. Bronchoscopy with bronchoalveolar lavage and tissue from a transbronchial lung cryobiopsy were non-diagnostic. Tissue from a video-assisted thoracoscopic surgery biopsy confirmed a diagnosis of PAP with IPH as a second separate pathology. The association of IPH and PAP has not previously been described. We discuss these conditions and postulate how and if they may be related.
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Affiliation(s)
- Laura Walsh
- Department of Respiratory Medicine, Cork University Hospital, Cork, Ireland
| | - Cormac McCarthy
- Department of Respiratory Medicine, St Vincent's University Hospital, Dublin, Ireland
| | - Michael Henry
- Department of Respiratory Medicine, Cork University Hospital, Cork, Ireland
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15
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Gocho K, Sato K, Imasaka K, Hamanaka N, Takahashi M, Shimizu K, Takemura T. Idiopathic Pulmonary Hemosiderosis Associated with Emphysematous Change in an Adult Who Underwent Lung Transplantation. Intern Med 2021; 60:117-122. [PMID: 32830179 PMCID: PMC7835464 DOI: 10.2169/internalmedicine.5142-20] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Accepted: 07/06/2020] [Indexed: 12/12/2022] Open
Abstract
Idiopathic pulmonary hemosiderosis is characterized by repeated alveolar hemorrhaging. We herein report a 52-year-old Japanese woman who had shortness of breath, diffuse small nodules, thin-walled cysts, and bronchiolectasis. A surgical lung biopsy revealed peribronchial hemosiderosis, centrilobular emphysema, and fragile elastic fibers of the alveolar septa and small vessels. She ultimately underwent living-donor lung transplantation five years after the first visit.
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Affiliation(s)
- Kyoko Gocho
- Department of Respiratory Medicine, Saiseikai Yokohamashi Tobu Hospital, Japan
| | - Kenya Sato
- Department of Respiratory Medicine, Saiseikai Yokohamashi Tobu Hospital, Japan
| | - Keisuke Imasaka
- Department of Respiratory Medicine, Saiseikai Yokohamashi Tobu Hospital, Japan
| | - Nobuyuki Hamanaka
- Department of Respiratory Medicine, Saiseikai Yokohamashi Tobu Hospital, Japan
| | - Miki Takahashi
- Department of Respiratory Medicine, Saiseikai Yokohamashi Tobu Hospital, Japan
| | - Kunihiko Shimizu
- Department of Respiratory Medicine, Saiseikai Yokohamashi Tobu Hospital, Japan
| | - Tamiko Takemura
- Department of Pathology, Kanagawa Cardiovascular and Respiratory Center, Japan
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16
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Deguchi K, Honjo N, Takata T, Touge T, Masaki T. Flail arm syndrome mimic caused by hemosiderin deposition in the anterior horn. Acta Neurol Belg 2020; 120:1487-1489. [PMID: 32885346 DOI: 10.1007/s13760-020-01489-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Accepted: 08/26/2020] [Indexed: 10/23/2022]
Affiliation(s)
- Kazushi Deguchi
- Department of Gastroenterology and Neurology, Kagawa University Faculty of Medicine, 1750-1 Ikenobe, Miki-cho, Kita-gun, Kagawa, 761-0793, Japan.
| | - Naomi Honjo
- Department of Neuroradiology, Osaka Neurosurgical Hospital, Kagawa, Japan
| | - Tadayuki Takata
- Department of Gastroenterology and Neurology, Kagawa University Faculty of Medicine, 1750-1 Ikenobe, Miki-cho, Kita-gun, Kagawa, 761-0793, Japan
| | - Tetsuo Touge
- Department of Health Sciences, Kagawa University Faculty of Medicine, Kagawa, Japan
| | - Tsutomu Masaki
- Department of Gastroenterology and Neurology, Kagawa University Faculty of Medicine, 1750-1 Ikenobe, Miki-cho, Kita-gun, Kagawa, 761-0793, Japan
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17
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Reed AW, Dabrowski A, Joseph S, Paranjape SM, Karwowski C. Lane-Hamilton Syndrome: An Illustration of Extraintestinal Manifestations of Celiac Disease. Clin Pediatr (Phila) 2020; 59:1195-1198. [PMID: 32686478 DOI: 10.1177/0009922820941210] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Affiliation(s)
- Anna W Reed
- Johns Hopkins Children's Center, Baltimore, MD, USA
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18
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Butt A, Ahmed R, Sheikh MDA, Khan O, Iqbal N, Rahman AJ, Khan JA. Idiopathic pulmonary hemosiderosis - A rare cause of chronic anemia. Monaldi Arch Chest Dis 2020; 90. [PMID: 32512987 DOI: 10.4081/monaldi.2020.1267] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2020] [Accepted: 04/24/2020] [Indexed: 11/23/2022] Open
Abstract
Idiopathic pulmonary hemosiderosis (IPH) is a rare disease marked by alveolar bleeding and accumulation of hemosiderin in the lungs. Here we present three cases of IPH. The first case is of a 26-year-old male with anemia, hemoptysis and dyspnea. Bronchoscopy confirmed diffuse alveolar hemorrhage (DAH). A diagnosis of IPH was made after ruling out other causes of DAH and observing good response to steroids. The patient's condition improved with prednisolone and azathioprine. The second case is of 26-year-old female with severe anemia. Imaging suggested IPH and lung biopsy confirmed it. She died shortly afterwards. The third case is of a 7-year-old male with chronic anemia. CT was suggestive of IPH and lung biopsy confirmed the diagnosis. Later, patient developed posterior reversible encephalopathy syndrome (PRES). This patient is stable on azathioprine and prednisolone. We aim to emphasize the importance of considering IPH as a differential in patients with DAH or chronic anemia.
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Affiliation(s)
- Ayesha Butt
- Aga Khan University Medical College, Karachi.
| | - Rashida Ahmed
- Section of Histopathology, Department of Pathology and Laboratory Medicine, Aga Khan University, Karachi.
| | | | - Omar Khan
- Jinnah Sindh Medical University, Karachi.
| | - Nousheen Iqbal
- Jinnah Sindh Medical University; 4Department of Medicine, Section of Pulmonary and Critical Care, Aga Khan University, Karachi.
| | | | - Javaid Ahmed Khan
- Department of Medicine, Section of Pulmonary and Critical Care, Aga Khan University, Karachi.
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19
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Temel MT, Temel L, Coskun ME, Konduk BT, Akbayram S, Demiryürek AT. Respiratory Distress and Severe Anemia in a Child With Idiopathic Pulmonary Hemosiderosis. J Pediatr Hematol Oncol 2019; 41:e254-e256. [PMID: 29683951 DOI: 10.1097/mph.0000000000001175] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Idiopathic pulmonary hemosiderosis is an infrequent cause of pulmonary hemorrhage in children. It is classically defined by the triad of recurrent hemoptysis, iron-deficiency anemia, and diffuse parenchymal infiltration without an obvious cause. The pathogenesis remains unexplained, diagnosis may be difficult, and the clinical course exceedingly variable. A 4-year-old girl was admitted to the hospital with complaints of dyspnea, and skin and mucous membrane pallor. The suspicion of idiopathic pulmonary hemosiderosis led to the use of corticosteroid therapy with rapid improvement in clinical condition and discharge from hospital.
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Affiliation(s)
| | - Levent Temel
- Pediatrics Clinic, Private Gaziantep Defa Life Hospital, Gaziantep, Turkey
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20
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Sasaki K, Ito Y, Kawame H, Kikuchi A, Tanaka H. Fatal case of Hajdu-Cheney syndrome with idiopathic pulmonary hemosiderosis. Pediatr Int 2019; 61:190-192. [PMID: 30767323 DOI: 10.1111/ped.13764] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2018] [Revised: 08/19/2018] [Accepted: 10/11/2018] [Indexed: 12/18/2022]
Affiliation(s)
- Kunihiro Sasaki
- Department of Pediatrics, Hachinohe Municipal City Hospital, Hachinohe, Japan
- Department of Pediatrics, Hirosaki University Hospital, Hirosaki, Japan
| | - Yoshinobu Ito
- Department of Pediatrics, Hachinohe Municipal City Hospital, Hachinohe, Japan
| | - Hiroshi Kawame
- Department of Pediatrics, Tohoku University Hospital, Sendai, Miyagi, Japan
| | - Atsuo Kikuchi
- Department of Pediatrics, Tohoku University Hospital, Sendai, Miyagi, Japan
| | - Hiroshi Tanaka
- Department of Pediatrics, Hirosaki University Hospital, Hirosaki, Japan
- Department of School Health Science, Faculty of Education, Hirosaki University, Hirosaki, Aomori, Japan
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21
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de Silva C, Mukherjee A, Jat KR, Lodha R, Kabra SK. Pulmonary Hemorrhage in Children: Etiology, Clinical Profile and Outcome. Indian J Pediatr 2019; 86:7-11. [PMID: 29948735 DOI: 10.1007/s12098-018-2725-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2018] [Accepted: 05/28/2018] [Indexed: 12/13/2022]
Abstract
OBJECTIVE To describe etiology, clinical profile, treatment and outcome of children with pulmonary hemorrhage. METHODS A chart review of children with pulmonary hemorrhage attending Pediatric Pulmonology services of a tertiary care hospital in North-India was done. RESULTS Data of 44 children (mean age 59.2 ± 32.1 mo; 28 boys) were included for the study. Possible idiopathic pulmonary hemosiderosis 16 (36.4%), post infectious complications 11 (25%), immune mediated disorders 8 (18.2%), cardiac and vascular disorders 7 (15.9%), and airway pathologies 2 (4.5%) were the etiologies of pulmonary hemorrhage. Treatment options like medications, bronchial artery embolization and surgical resections were offered according to the etiology. Children with idiopathic pulmonary hemosiderosis and those with immune mediated diseases were treated with systemic steroids and steroid sparing agents; the latter group took longer time to respond and had more relapses. CONCLUSIONS Identification of main etiological categories of pulmonary hemorrhage in children could be useful to plan investigations and management of wide range of causes in more practical way.
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Affiliation(s)
- Channa de Silva
- Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, 110029, India
| | - Aparna Mukherjee
- Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, 110029, India
| | - Kana Ram Jat
- Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, 110029, India
| | - Rakesh Lodha
- Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, 110029, India
| | - Sushil Kumar Kabra
- Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, 110029, India.
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22
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Noronha N, Ramalho P, Barreira R, Roda J, Silva TR, Félix M. Severe iron-deficiency anemia as initial manifestation of pulmonary hemosiderosis in a child. Einstein (Sao Paulo) 2018; 16:eRC4505. [PMID: 30517370 PMCID: PMC6276813 DOI: 10.31744/einstein_journal/2018rc4505] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2018] [Accepted: 09/13/2018] [Indexed: 11/05/2022] Open
Abstract
Idiopathic pulmonary hemosiderosis is a potentially fatal disease that results from episodes of alveolar hemorrhage of unknown origin. The clinical spectrum is varied, and anemia may constitute the only manifestation of illness, preceding other signs and symptoms by several months. We present the case of a 4 year-old child presenting with fever, vomiting and prostration, associated with pallor. He had microcytic and hypochromic anemia refractory to iron therapy. Gastrointestinal bleeding was ruled out after negative extensive etiological investigation. Subsequently, pulmonary infiltrates suggestive of alveolar hemorrhage were observed in the chest radiography. The cytological exam of the bronchoalveolar lavage showed hemosiderin-laden macrophages. After the etiological study, the diagnosis of idiopathic pulmonary hemosiderosis was made by exclusion. He was initiated on corticosteroid therapy, later associated to an immunosuppressive agent, with subsequent correction of anemia and of the radiological pattern. The patient is currently asymptomatic.
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Affiliation(s)
- Natália Noronha
- Serviço de Cardiologia Pediátrica, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
- Serviço de Pediatria Médica, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - Pedro Ramalho
- Serviço de Pediatria Médica, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
- Serviço de Pneumologia, Hospital Geral, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - Rogério Barreira
- Serviço de Anatomia Patológica, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - Juliana Roda
- Serviço de Pediatria Médica, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - Teresa Reis Silva
- Serviço de Pediatria Médica, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - Miguel Félix
- Serviço de Pediatria Médica, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
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23
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Imafuku A, Yamamoto G, Takemura K, Hasegawa E, Sawa N, Kawada M, Sekine A, Hoshino J, Takaichi K, Fujii T, Ohashi K, Ubara Y. Acute Kidney Injury by Renal Hemosiderosis Secondary to Primary Cold Agglutinin Disease Associated with an Excessive Alcohol Intake. Intern Med 2018; 57:3261-3265. [PMID: 29984743 PMCID: PMC6287995 DOI: 10.2169/internalmedicine.0710-17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Renal hemosiderosis occurs in the context of severe intravascular hemolysis, with the most common cause being paroxysmal nocturnal hematuria. Patients with cold agglutinin disease (CAD) have relatively mild hemolysis, and acute kidney injury (AKI) due to renal hemosiderosis has not been reported. We encountered a patient with CAD caused by lymphoplasmacytic lymphoma who developed AKI secondary to renal hemosiderosis after an excessive alcohol intake.
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Affiliation(s)
- Aya Imafuku
- Nephrology Center, Toranomon Hospital, Japan
| | - Go Yamamoto
- Hematology Center, Toranomon Hospital, Japan
| | | | | | - Naoki Sawa
- Nephrology Center, Toranomon Hospital, Japan
| | | | | | | | | | | | - Kenichi Ohashi
- Department of Pathology, Yokohama City University, Graduate School of Medicine, Japan
| | - Yoshifumi Ubara
- Nephrology Center, Toranomon Hospital, Japan
- Okinaka Memorial Institute for Medical Research, Japan
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24
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Watanabe M, Ohyama K, Suzuki M, Nosaki Y, Hara T, Iwai K, Kono S, Miyajima H, Mokuno K. Aceruloplasminemia with Abnormal Compound Heterozygous Mutations Developed Neurological Dysfunction during Phlebotomy Therapy. Intern Med 2018; 57:2713-2718. [PMID: 29709961 PMCID: PMC6191604 DOI: 10.2169/internalmedicine.9855-17] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Aceruloplasminemia is an autosomal recessive inherited disorder caused by ceruloplasmin gene mutations. The loss of ferroxidase activity of ceruloplasmin due to gene mutations causes a disturbance in cellular iron transport. We herein describe a patient with aceruloplasminemia, who presented with diabetes mellitus that was treated by insulin injections, liver hemosiderosis treated by phlebotomy therapy, and neurological impairment. A genetic analysis of the ceruloplasmin gene revealed novel compound heterozygous mutations of c.1286_1290insTATAC in exon 7 and c.2185delC in exon 12. This abnormal compound heterozygote had typical clinical features similar to those observed in aceruloplasminemia patients with other gene mutations.
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Affiliation(s)
- Maki Watanabe
- Department of Neurology, Toyohashi Municipal Hospital, Japan
| | - Ken Ohyama
- Department of Neurology, Toyohashi Municipal Hospital, Japan
| | - Masashi Suzuki
- Department of Neurology, Toyohashi Municipal Hospital, Japan
- Department of Neurology, Nagoya University Graduate School of Medicine, Japan
| | - Yasunobu Nosaki
- Department of Neurology, Toyohashi Municipal Hospital, Japan
| | - Takashi Hara
- Department of Neurology, Toyohashi Municipal Hospital, Japan
| | - Katsushige Iwai
- Department of Neurology, Toyohashi Municipal Hospital, Japan
| | - Satoshi Kono
- First Department of Medicine, Hamamatsu University School of Medicine, Japan
| | - Hiroaki Miyajima
- First Department of Medicine, Hamamatsu University School of Medicine, Japan
| | - Kenji Mokuno
- Department of Neurology, Toyohashi Municipal Hospital, Japan
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25
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26
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Silva P, Ferreira PG. Idiopathic pulmonary hemosiderosis: Hemorrhagic flare after 6 years of remission. Rev Port Pneumol (2006) 2017; 23:368-369. [PMID: 28844597 DOI: 10.1016/j.rppnen.2017.07.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2017] [Revised: 07/20/2017] [Accepted: 07/23/2017] [Indexed: 11/23/2022] Open
Affiliation(s)
- P Silva
- Respiratory Department, Centro Hospitalar do Baixo Vouga (CHBV), Aveiro, Portugal.
| | - P G Ferreira
- Respiratory Department, Centro Hospitalar do Baixo Vouga (CHBV), Aveiro, Portugal
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27
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Li YT, Guo YX, Cai LM, Pan L, Duan MQ, Yang LF, Sun YY, Tan WP, Chen ZG. Methylprednisolone pulse therapy rescued life-threatening pulmonary hemorrhage due to idiopathic pulmonary hemosiderosis. Am J Emerg Med 2017; 35:1786.e3-1786.e7. [PMID: 28784257 DOI: 10.1016/j.ajem.2017.07.094] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2017] [Accepted: 07/30/2017] [Indexed: 12/16/2022] Open
Abstract
Idiopathic pulmonary hemosiderosis (IPH) is an extremely rare cause of massive pulmonary hemorrhage in children. During the acute phase, death due to massive alveolar hemorrhage and subsequent severe respiratory failure. We report two cases of IPH children who developed hypoxemic respiratory failure and massive pulmonary hemorrhage. One case of a 10-year-old boy was treated with methylprednisolone pulse therapy (10mg/kg/d) for the first three days and followed by systemic steroid therapy, he successfully decannulated 10days later and discharged with a favorable quality of life. Another case of a 4year-old female child with Down's syndrome diagnosed as IPH for over one year and treated with oral corticosteroids for maintenance therapy. She sudden suffered severe hypoxemia with rapid falls in the hemoglobin level. We applied methylprednisolone pulse therapy (10mg/kg/d) for three days and other supportive therapies, the girl survived through complicated with oxygen dependence. We suggest that methylprednisolone pulse therapy provides a chance of recovery and survival for patients with IPH at the acute phase, even if accompanied by severe pulmonary hemorrhage.
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Affiliation(s)
- Ya-Ting Li
- Pediatric Intensive Care Unit, Department of Pediatrics, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou 510630, PR China.
| | - Yu-Xiong Guo
- Pediatric Intensive Care Unit, Department of Pediatrics, Guangdong General Hospital, Guangdong Academic of Medical Sciences, Guangzhou 510080, PR China.
| | - Liang-Ming Cai
- Pediatric Intensive Care Unit, Department of Pediatrics, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou 510630, PR China.
| | - Li Pan
- Pediatric Intensive Care Unit, Department of Pediatrics, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou 510630, PR China.
| | - Meng-Qi Duan
- Pediatric Intensive Care Unit, Department of Pediatrics, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou 510630, PR China.
| | - Li-Fen Yang
- Pediatric Intensive Care Unit, Department of Pediatrics, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou 510630, PR China.
| | - Yue-Yu Sun
- Pediatric Intensive Care Unit, Department of Pediatrics, Guangdong General Hospital, Guangdong Academic of Medical Sciences, Guangzhou 510080, PR China.
| | - Wei-Ping Tan
- Department of Pediatrics, The Sun Yat-Sen Memorial Hospital of Sun Yat-Sen University, Guangzhou 510120, PR China.
| | - Zhuang-Gui Chen
- Pediatric Intensive Care Unit, Department of Pediatrics, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou 510630, PR China.
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28
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Chen XY, Sun JM, Huang XJ. Idiopathic pulmonary hemosiderosis in adults: review of cases reported in the latest 15 years. Clin Respir J 2017; 11:677-681. [PMID: 26692115 DOI: 10.1111/crj.12440] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/21/2015] [Revised: 11/24/2015] [Accepted: 12/14/2015] [Indexed: 11/26/2022]
Abstract
BACKGROUND Idiopathic pulmonary hemosiderosis (IPH) is a rare disorder of unknown etiology which can cause diffuse alveolar hemorrhage. IPH is found primarily in children. In adults, however, it is extremely rare. A systematic review was applied to identify the details of IPH in adults. METHODS Articles of English or Chinese language published between 2000 and 2015 were included. Data were extracted on the clinical features, examinations, treatments and clinical outcome. RESULTS A total of 37 cases of adult-onset IPH were included (13 females and 24 males). IPH combined with coeliac disease was found in five patients, three of whom received gluten-free diet (GFD) only and got full remission. Upon diagnosis, median age was 34 years. The main manifestations were: hemoptysis (n = 30, 81%), dyspnea (n = 23, 64%), anemia (n = 20, 54%). Most patients were treated by corticosteroids initially. The mortality rage was 14% on acute phase. CONCLUSION The adult patients in this study showed some differences from the previously characterized IPH. It is characterized by immunologically mediated, middle-age onset, male dominance, absence of anemia, high mortality on acute phase.
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Affiliation(s)
- Xi-Yuan Chen
- Department of Respiratory Medicine, Zhejiang Provincial People's Hospital, Hangzhou, 310014, China
| | - Jin-Ming Sun
- Department of Respiratory Medicine, The People's No.3 Hospital of Hangzhou Xiaoshan, Hangzhou, 311251, China
| | - Xiao-Jun Huang
- Department of Respiratory Medicine, Zhejiang Provincial People's Hospital, Hangzhou, 310014, China
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29
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Imoto N, Shiraki A, Furukawa K, Tange N, Murase A, Hayakawa M, Iwata Y, Kosugi H. Welder's pulmonary hemosiderosis associated with systemic iron overload following exacerbation of acute adult T-cell leukemia/lymphoma. J Clin Exp Hematop 2017; 57:74-78. [PMID: 28883221 PMCID: PMC6158058 DOI: 10.3960/jslrt.17024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2017] [Revised: 06/26/2017] [Accepted: 07/18/2017] [Indexed: 11/01/2022] Open
Abstract
Herein, we describe a 61-year-old man diagnosed with pulmonary hemosiderosis following chemotherapy for acute adult T-cell leukemia/lymphoma (ATLL). Liver and heart biopsy confirmed hemosiderosis. ATLL progressed, and the patient died from multiorgan damage. Welder's lung may have been involved in hemosiderosis and systemic iron overload. Abnormal iron metabolism or immune reactions may have influenced the clinical course, but these were not validated. Detailed analyses of family medical and lifestyle histories, and genetic examination should be performed in cases of systemic iron overload.
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30
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Pekic S, Popovic V. DIAGNOSIS OF ENDOCRINE DISEASE: Expanding the cause of hypopituitarism. Eur J Endocrinol 2017; 176:R269-R282. [PMID: 28258131 DOI: 10.1530/eje-16-1065] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/25/2016] [Revised: 02/17/2017] [Accepted: 03/02/2017] [Indexed: 12/14/2022]
Abstract
Hypopituitarism is defined as one or more pituitary hormone deficits due to a lesion in the hypothalamic-pituitary region. By far, the most common cause of hypopituitarism associated with a sellar mass is a pituitary adenoma. A high index of suspicion is required for diagnosing hypopituitarism in several other conditions such as other massess in the sellar and parasellar region, brain damage caused by radiation and by traumatic brain injury, vascular lesions, infiltrative/immunological/inflammatory diseases (lymphocytic hypophysitis, sarcoidosis and hemochromatosis), infectious diseases and genetic disorders. Hypopituitarism may be permanent and progressive with sequential pattern of hormone deficiencies (radiation-induced hypopituitarism) or transient after traumatic brain injury with possible recovery occurring years from the initial event. In recent years, there is increased reporting of less common and less reported causes of hypopituitarism with its delayed diagnosis. The aim of this review is to summarize the published data and to allow earlier identification of populations at risk of hypopituitarism as optimal hormonal replacement may significantly improve their quality of life and life expectancy.
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Affiliation(s)
- Sandra Pekic
- School of MedicineUniversity of Belgrade, Belgrade, Serbia
- Clinic of EndocrinologyDiabetes and Metabolic Diseases, University Clinical Center Belgrade, Belgrade, Serbia
| | - Vera Popovic
- School of MedicineUniversity of Belgrade, Belgrade, Serbia
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Ahmed M, Raj D, Kumar A, Kumar A. Anaemia and respiratory failure in a child: can it be idiopathic pulmonary haemosiderosis? BMJ Case Rep 2017; 2017:bcr-2017-219431. [PMID: 28512100 PMCID: PMC5612269 DOI: 10.1136/bcr-2017-219431] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/14/2017] [Indexed: 11/04/2022] Open
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.
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Affiliation(s)
| | - Dinesh Raj
- Department of Pediatrics, Holy Family Hospital, New Delhi, India
| | - Ashwini Kumar
- Department of Pediatrics, Holy Family Hospital, New Delhi, India
| | - Abhay Kumar
- Department of Pediatrics, Holy Family Hospital, New Delhi, India
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Affiliation(s)
- Caren Pichardo
- *Department of Medical Education, Miami Children's Hospital †Department of Pediatric Gastroenterology, Miami Children's Hospital ‡Department of Pathology, Miami Children's Hospital, Miami, FL
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Doğruel D, Erbay A, Yazici N, Arslan A, Hasbay Biçen B. A Case of Idiopathic Pulmonary Hemosiderosis Presenting With Signs and Symptoms Mimicking Hemolytic Anemia. J Pediatr Hematol Oncol 2017; 39:e15-e17. [PMID: 27918350 DOI: 10.1097/mph.0000000000000722] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Idiopathic pulmonary hemosiderosis is primarily a disorder of childhood, which is characterized by hemoptysis, iron deficiency anemia, and diffuse parenchymal infiltrates on chest x-ray secondary to recurrent attacks of alveolar hemorrhage. It can be diagnosed by showing hemosiderin laden macrophages in bronchoalveolar lavage fluid after other specific causes of diffuse alveolar hemorrhage are definitely excluded. A 5-year-old male patient was admitted to our clinic with sudden-onset pallor during iron therapy given for anemia. While he was being investigated for clinical and laboratory signs mimicking hemolytic anemia, he developed cough and dyspnea. He had infiltrates on chest x-ray and scattered patchy infiltrates in both lungs on high-resolution computed tomography. Hemosiderin laden macrophages were identified in fasting gastric juice and bronchoalveolar lavage fluid. The patient was diagnosed with idiopathic pulmonary hemosiderosis and started corticosteroid therapy.
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Affiliation(s)
- Dilek Doğruel
- Departments of *Pediatric Allergy and Immunology †Pediatric Hematology and Oncology ‡Pediatric Cardiology §Pathology, Adana Teaching and Medical Research Center, Baskent University Faculty of Medicine, Adana, Turkey
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34
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Popp A, Jurcuţ C, Balaban DV, Șotcan M, Laurila K, Jinga M. Severe Alveolar Hemorrhage - What's in it for the Gastroenterologist? J Gastrointestin Liver Dis 2016; 25:555-558. [PMID: 27981314 DOI: 10.15403/jgld.2014.1121.254.cut] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND Alveolar hemorrhage is a potentially life-threatening condition which is usually managed by the pulmonologist. When considering its etiology, there is a rare association that sets the disease into the hands of the gastroenterologist. CASE PRESENTATION We report the case of a 48 year-old female who was admitted to the intensive care unit for severe anemia and hemoptysis. On imaging, diffuse pulmonary infiltrates suggestive of alveolar hemorrhage were detected and a diagnosis of pulmonary hemosiderosis was made. She received cortisone therapy and hematologic correction of anemia, with slow recovery. In search of an etiology for the pulmonary hemosiderosis, an extensive workup was done, and celiac disease specific serology was found positive. After confirmation of celiac disease by biopsy, a diagnosis of Lane-Hamilton syndrome was established. The patient was recommended a gluten-free diet and at 6 months follow-up, resolution of anemia and pulmonary infiltrates were observed. CONCLUSION Although the association is rare, celiac disease should be considered in a patient with idiopathic pulmonary hemosiderosis. In our case, severe anemia and alveolar infiltrates markedly improved with glucocorticoids and gluten-free diet.
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Affiliation(s)
- Alina Popp
- Carol Davila University of Medicine and Pharmacy; Alessandrescu-Rusescu National Institute for Mother and Child Health; Bucharest, Romania; Tampere Center for Child Health Research, University of Tampere and Tampere University Hospital, Finland
| | - Ciprian Jurcuţ
- Dr. Carol Davila Central University Emergency Military Hospital, Bucharest, Romania.
| | | | - Mihai Șotcan
- Dr. Carol Davila Central University Emergency Military Hospital, Bucharest, Romania
| | - Kaija Laurila
- Tampere Center for Child Health Research, University of Tampere and Tampere University Hospital, Finland
| | - Mariana Jinga
- Carol Davila University of Medicine and Pharmacy; Dr. Carol Davila Central University Emergency Military Hospital, Bucharest, Romania
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Erkoçoğlu M, Civelek E, Kocabaş CN. Unusual presentation: Concurrent IgA deficiency and idiopathic pulmonary hemosiderosis. Pediatr Pulmonol 2016; 51:E34-E36. [PMID: 27120139 DOI: 10.1002/ppul.23445] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2016] [Revised: 03/21/2016] [Accepted: 04/04/2016] [Indexed: 11/06/2022]
Abstract
Idiopathic pulmonary hemosiderosis (IPH) is a rare disorder that should be considered in the differential diagnosis of patients with hemoptysis, recurrent alveolar hemorrhage, dyspnea and iron deficiency anemia (IDA). The frequent association of autoimmune disorders with IPH and a favorable response to steroids suggest the presence of an underlying immune disorder. Here we present a case of a patient with cough, fever, and cyanosis who was also diagnosed with IPH and concurrent selective immunoglobulin A deficiency. This presentation is a unique presentation because of the co-occurrence of these two disorders. Pediatr Pulmonol. 2016;51:E34-E36. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Mustafa Erkoçoğlu
- Department of Pediatric Allergy and Immunology, Abant Izzet Baysal University Faculty of Medicine, Bolu, Turkey.
| | - Ersoy Civelek
- Department of Pediatric Allergy and Immunology, Ankara Pediatric and Pediatric Hematology Oncology Training and Research Hospital, Ankara, Turkey
| | - Can Naci Kocabaş
- Department of Pediatric Allergy and Immunology, Mugla Sıtkı Kocman University Faculty of Medicine, Mugla, Turkey
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36
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Abstract
Idiopathic pulmonary hemosiderosis (IPH) is a rare disease characterized by the triad of hemoptysis, pulmonary infiltrates on chest radiograph, and anemia. Its diagnosis should be considered in any child presenting with moderate to severe anemia and failure to thrive of unclear etiology. Consideration of the differential diagnosis in such a child should include the review of both extravascular and intravascular causes of hemolysis. Systemic treatment of IPH with glucocorticoids has been shown to decrease morbidity, mortality, and disease progression to pulmonary fibrosis. Thus, diagnostic delays can impact prognosis. Here, we present a case of a 15-month-old boy with IPH who presented with anemia, jaundice, and failure to thrive, as well as a history of hemoptysis that was not initially elicited.
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Affiliation(s)
- Carol C Chen
- From the Sections of *Emergency Medicine, and †Pulmonary Medicine, Department of Pediatrics, Baylor College of Medicine, Houston, TX
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Nascimento-Alves P, Fernandes-Silva H, Aragão-Homem C, Geraldes R, Fonseca AC. IV and V cranial nerves dysfunction as initial manifestations of superficial siderosis of the central nervous system. Rev Neurol 2016; 62:334-335. [PMID: 26988173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Affiliation(s)
| | | | | | - Ruth Geraldes
- Hospital de Santa Maria, Lisboa, Portugal
- Universidade de Lisboa, Lisboa, Portugal
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Abstract
OBJECTIVE To investigate the etiology and clinical manifestation of hemoptysis in children. METHOD A retrospective analysis was performed for 106 cases of hemoptysis who were admitted to The Second Affiliated Hospital & Yuying Children's Hospital of Wenzhou Medical University from January 2005 to December 2014.The clinical information including laboratory tests and image data were collected and analyzed. RESULT A total of 106 patients (50 males and 56 females) were identified. The median age was 9.1 years (range 2 months to 18 years). Pneumonia (35, 31.1%) was the most common etiology of hemoptysis, which included bacterial pneumonia (27 cases), mycoplasmal pneumonia(4 cases), chlamydial pneumonia (3 cases), and influenza pneumonia(1 case). Other causes included bronchitis(15, 14.2%), pulmonary tuberculosis (11, 10.4%), bronchiectasis (11, 10.4%), diffuse alveolar hemorrhage (8, 7.5%), idiopathic pulmonary hemosiderosis(6, 5.7%), cardiovascular dysplasia(6, 5.7%), pulmonary contusion (4, 3.8%), foreign body in bronchus (2, 1.9%), allergic bronchopulmonary aspergillosis (2, 1.9%). Eighty-six patients manifested mild hemoptysis; moderate and massive hemoptysis were found in nine and eleven patients, respectively. Pneumonia accounted for 33.7% of mild hemoptysis and 45.5% of massive hemoptysis were due to bronchiectasis; 80.2% were treated with antibiotics and 41.5% were given hemostatic agents; 8.5% received lobectomy. Ninety-six patients (90.6%) were cured and parents gave up treatment in 4 cases (3.8%). Six patients (5.7%) suffered from recurrent hemoptysis. CONCLUSION Hemoptysis mainly occurred in children who were older than 6 years, the most common cause of hemoptysis was respiratory tract infection. In most cases, the amount of hemoptysis was small and the overall prognosis was good.
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Affiliation(s)
- Kangkang Yang
- Department of Pulmonology, The Second Affiliated Hospital & Yuying Children's Hospital, Wenzhou Medical University, Wenzhou 325027, China
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39
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Eldem İ, İleri T, İnce E, Asarcikli F, Pekpak E, Çakmakli HF, Ceyhan K, Uysal Z. Idiopathic Pulmonary Hemosiderosis With Allergic Asthma Diagnosis in a Pediatric Patient. J Pediatr Hematol Oncol 2015; 37:e435-7. [PMID: 26241728 DOI: 10.1097/mph.0000000000000412] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Idiopathic pulmonary hemosiderosis (IPH) is a rare disorder with unknown pathogenesis that usually presents in the first decade of life. As a result of diffuse alveolar hemorrhage, respiratory symptoms such as cough attacks, hemoptysis, dyspnea, and recurrent and refractory iron-deficiency anemia (IDA) are observed. We present an 8-year-old girl who was followed up with recurrent IDA and allergic asthma and later diagnosed with IPH. IPH was confirmed by the presence of hemosiderin-laden macrophages in bronchoalveolar lavage obtained by bronchoscopy and exclusion of the secondary causes of pulmonary hemosiderosis. Glucocorticoids and iron supplementation were started. Clinical and laboratory improvement was observed with therapy. Our case illustrates that refractory/recurrent IDA with any pulmonary symptoms may be the only presenting feature of IPH.
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Affiliation(s)
- İrem Eldem
- Departments of *Pediatrics †Pediatric Hematology ‡Pathology, Ankara University School of Medicine, Dikimevi, Ankara, Turkey
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40
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Kondziella D, Lindelof M, Haziri D, Larsen VA, Kruse A. Diagnostic and therapeutic challenges in superficial CNS siderosis. Dan Med J 2015; 62:A5079. [PMID: 26050830] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
INTRODUCTION Superficial CNS siderosis was previously almost unknown but is now diagnosed with increasing frequency owing to magnetic resonance imaging. Patients may present with sensory deafness, gait ataxia, various sensorimotor signs and, eventually, cognitive decline. They typically have a history of traumatic brain or spinal cord injury or previous neurosurgery, or may harbour congenital malformations. However, knowledge about treatment outcomes remains scarce. METHODS We present a series of nine consecutive patients from a large tertiary neuroscience centre in order to highlight the challenges related to the diagnosis and treatment of superficial siderosis. RESULTS A potential bleeding aetiology was identified in all patients, but removal of the offending bleeding source was achieved only in three (33%). Symptom progression was halted in just one patient (11%), which suggests that neurodegeneration due to haemosiderin-associated iron toxicity becomes irreversible with time. CONCLUSION Surgical therapy in superficial CNS siderosis is rarely achieved. We suggest that prospective, large-scale multicentre studies are needed to search for non-surgical therapies that reverse (or prevent) ongoing neurotoxicity due to accumulating iron toxicity. FUNDING not relevant. TRIAL REGISTRATION not relevant.
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Affiliation(s)
- Daniel Kondziella
- Neurologisk Afdeling, Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark.
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41
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Calvo M, de Miguel C, Pinel A, Ortega JM, Aladro Y. [Diffuse superficial siderosis of the central nervous system: four case reports and review of the literature]. Rev Neurol 2014; 59:354-358. [PMID: 25297478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
INTRODUCTION Diffuse superficial siderosis of the central nervous system (CNS) is a rare condition due to hemosiderin deposits in the subpial layers of the brain and spinal cord. The source of chronic or recurrent bleeding into the subarachnoid space is detected in only 50 % of cases. The most characteristic symptoms are cerebellar ataxia and sensorineural hearing impairment. T2-weighted gradient echo magnetic resonance imaging constitutes the diagnostic method of choice. CASE REPORTS We report four patients of diffuse superficial siderosis of the CNS associated to cerebral amyloid angiopathy, oral anticoagulation, schwannoma VIII, and without known source of bleeding in one case. Two patients developed cerebellar ataxia, three of them present transient focal neurological episodes, one dementia and, the last one, the diffuse superficial siderosis of the CNS is a radiological finding. No clinical progression was observed during follow-up (2-11 years) in three of them. The patient with cerebral amyloid angiopathy progresses to dementia. CONCLUSIONS Transient focal neurological episodes were the most common symptom in our cases of diffuse superficial siderosis of the CNS. The natural history of this condition is not very known and may be regarded as a radiological finding.
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Affiliation(s)
- Marta Calvo
- Hospital Universitario de Getafe, 28905 Getafe, Espana
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42
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Lewis AE, Høi-Hansen CE, Buchvald F, Petersen W. [Idiopathic pulmonary haemosiderosis in a one-year-old girl with Down syndrome]. Ugeskr Laeger 2014; 176:V04140253. [PMID: 25294331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Idiopathic pulmonary haemosiderosis (IPH) is a rare disease. We describe a girl with Down syndrome who had no major respiratory symptoms until one year of age, where recurrent airway infections and chronic anaemia of unknown aetiology developed. At 20 months of age she had intermittent haemo-ptysis, was investigated with computed tomography and broncho-alveolar lavage and was diagnosed with IPH. After treatment, respiratory symptoms and anaemia resolved and a positive impact on previously impaired growth and psychomotor development was seen. Paediatricians should consider IPH in children with recurrent respiratory symptoms and anaemia.
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Affiliation(s)
- Anna Elisabeth Lewis
- Børne- og Ungeafdelingen, Nordsjællands -Hospital, Hillerød, Dyrehavevej 29, 3400 Hillerød. E-mail:
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Mahut B, Fuchs-Climent D, Plantier L, Karila C, Refabert L, Chevalier-Bidaud B, Beydon N, Peiffer C, Delclaux C. Cross-sectional assessment of exertional dyspnea in otherwise healthy children. Pediatr Pulmonol 2014; 49:772-81. [PMID: 24155055 DOI: 10.1002/ppul.22905] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2013] [Accepted: 07/10/2013] [Indexed: 11/11/2022]
Abstract
OBJECTIVES Exertional dyspnea during sport at school in children with asthma or in otherwise healthy children is commonly attributed to exercise-induced asthma (EIA), but when a short-acting beta agonist (SABA) trial fails to improve symptoms the physician is often at a loose end. DESIGN The aims were to prospectively assess the causes of exertional dyspnea in children/adolescents with or without asthma using a cardiopulmonary exercise test while receiving a SABA and to assess the effects of standardized breathing/reassurance therapy. RESULTS Seventy-nine patients (12.2 ± 2.3 years, 41 girls, 49 with previously diagnosed asthma) with dyspnea unresponsive to SABA were prospectively included. Exercise test outcomes depicted normal or subnormal performance with normal ventilatory demand and capacity in 53/79 children (67%) defining a physiological response. The remaining 26 children had altered capacity (resistant EIA [n = 17, 9 with previous asthma diagnosis], vocal cord dysfunction [n = 2]) and/or increased demand (alveolar hyperventilation [n = 3], poor conditioning [n = 7]). Forty-two children who had similar characteristics than the remaining 37 children underwent the two sessions of standardized reassurance therapy. They all demonstrated an improvement that was rated "large." The degree of improvement correlated with % predicted peak V'O2 (r = -0.37, P = 0.015) and peak oxygen pulse (r = -0.45, P = 0.003), whatever the underlying dyspnea cause. It suggested a higher benefit in those with poorer conditioning condition. CONCLUSIONS The most frequent finding in children/adolescents with mild exertional dyspnea unresponsive to preventive SABA is a physiological response to exercise, and standardized reassurance afforded early clinical improvement, irrespective of the dyspnea cause.
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Affiliation(s)
- Bruno Mahut
- AP-HP, Hôpital Européen Georges Pompidou, Service de Physiologie-Clinique de la Dyspnée, Paris, France; Cabinet La Berma, Antony, France
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Yuan Z, Shen Z, Guo L, Wang X, Wang S, Zhao B. Improving detection of siderotic nodules in patients with liver disease using 2D ESWAN technique. Acad Radiol 2014; 21:971-6. [PMID: 25018068 DOI: 10.1016/j.acra.2014.03.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2013] [Revised: 03/10/2014] [Accepted: 03/11/2014] [Indexed: 01/17/2023]
Abstract
RATIONALE AND OBJECTIVES To conduct a preliminary evaluation of the use of two-dimensional (2D) enhanced multiecho T2*-weighted angiography (ESWAN) sequence for detection and quantification of siderotic nodules (SNs) in patients with liver disease. MATERIALS AND METHODS Seventy-four patients with liver cirrhosis SNs confirmed by pathology were imaged using conventional T1-weighted imaging (T1WI), T2-weighted imaging (T2WI), T2*-weighted imaging (T2*WI), and 2D ESWAN. The signal intensity ratio (SIR) and the lesion-to-liver contrast-to-noise ratio (CNR) were calculated. The quality of SNs identification of the ESWAN images was evaluated. RESULTS The SIR of SNs on ESWAN was lower than those in any other sequence, whereas the CNR of SNs on ESWAN was significantly greater than those in the other sequences (P < .05). The conspicuity of SNs was shown to be significantly different between every pair of techniques (P < .05). The nodules had the better conspicuity in ESWAN images than in the T1WI, T2WI, and T2*WI. Almost all (97.3%, 72 of 74) patients were considered to have excellent grade 3 conspicuity on ESWAN imaging, compared to 40.5% (30 of 74) for T2*WI. The signal intensity of small hepatic cancer on ESWAN was greater than those of SNs. CONCLUSIONS The detection and conspicuity of SNs is substantially improved using breath-hold 2D ESWAN. Therefore, 2D ESWAN imaging may be an alternative for the accurate detection of hepatic SNs in the future.
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Affiliation(s)
- Zhenguo Yuan
- Shandong Medical Imaging Research Institute, Shandong University, Jinan, Shandong, China
| | - Zhen Shen
- Medical Imaging Center of the Affiliated Hospital, Weifang Medical University, 7166#, Baotong West St, Weifang, Shandong 261053, China
| | - Lingfei Guo
- Shandong Medical Imaging Research Institute, Shandong University, Jinan, Shandong, China
| | - Xizhen Wang
- Medical Imaging Center of the Affiliated Hospital, Weifang Medical University, 7166#, Baotong West St, Weifang, Shandong 261053, China.
| | - Shiyan Wang
- Taishan Medical University, Taian, Shandong, China
| | - Bin Zhao
- Shandong Medical Imaging Research Institute, Shandong University, Jinan, Shandong, China
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Martínez Carapeto I, Montero Valladares C, Sánchez Alvarez MJ, Loscertales Abril M. [Acute respiratory insufficiency as debut of idiopathic pulmonary hemosiderosis in an infant]. An Pediatr (Barc) 2014; 80:e22-3. [PMID: 23684173 DOI: 10.1016/j.anpedi.2013.03.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2012] [Revised: 03/13/2013] [Accepted: 03/31/2013] [Indexed: 11/16/2022] Open
Affiliation(s)
- I Martínez Carapeto
- Unidad de Gestión Clínica de Cuidados Críticos y Urgencias Pediátricas, Hospital Infantil Virgen del Rocío, Sevilla, España.
| | - C Montero Valladares
- Unidad de Gestión Clínica de Cuidados Críticos y Urgencias Pediátricas, Hospital Infantil Virgen del Rocío, Sevilla, España
| | - M J Sánchez Alvarez
- Unidad de Gestión Clínica de Cuidados Críticos y Urgencias Pediátricas, Hospital Infantil Virgen del Rocío, Sevilla, España
| | - M Loscertales Abril
- Unidad de Gestión Clínica de Cuidados Críticos y Urgencias Pediátricas, Hospital Infantil Virgen del Rocío, Sevilla, España
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Koutsonas A, Plange N, Roessler GF, Walter P, Mazinani BA. A case of siderosis bulbi without a radiologically detectable foreign body. Can J Ophthalmol 2013; 48:e9-e11. [PMID: 23419313 DOI: 10.1016/j.jcjo.2012.09.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2012] [Revised: 08/25/2012] [Accepted: 09/04/2012] [Indexed: 11/29/2022]
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Chauhan A, Urrego F, Warrier R. Wandering pneumonia, recurrent hemoptysis, and anemia in a child with sickle cell trait. Clin Pediatr (Phila) 2013; 52:471-4. [PMID: 23420412 DOI: 10.1177/0009922813476574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Aman Chauhan
- Louisiana State University Health Sciences Center, New Orleans, LA, USA
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Bhattacharya M, Kapoor S, Dubey AP. Celiac disease presentation in a tertiary referral centre in India: current scenario. Indian J Gastroenterol 2013; 32:98-102. [PMID: 22903368 DOI: 10.1007/s12664-012-0240-y] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2012] [Accepted: 07/27/2012] [Indexed: 02/07/2023]
Abstract
BACKGROUND Nondiarrheal celiac disease (NDCD) is being increasingly reported but data from India is limited. AIM We undertook this study to compare the clinical spectrum of NDCD with that of diarrheal/classical celiac disease (CCD). METHOD This facility-based retrospective observational study included consecutive patients diagnosed with celiac disease (CD) (as per modified ESPGHAN criteria) from October 2009 to August 2011. RESULTS A total of 381 patients were diagnosed with CD during the study period. NDCD was present in 192 (51.8 %). NDCD had higher mean age at presentation (5.8 ± 2.8 vs. 6.9 ± 2.9 years respectively; p = 0.003) and longer duration of symptoms prior to diagnosis (2.9 ± 1.7 years vs. 3.6 ± 2.2 years; p = 0.02) as compared to CCD. In the NDCD group, the most frequent gastrointestinal (GI) symptoms were recurrent abdominal pain [122 (63.5 %)] and abdominal distension [102 (53.1 %)] followed by constipation [48 (25 %)], vomiting [76 (39.6 %)] and recurrent oral ulcers [89 (46.4 %)]. Vomiting and constipation were more frequently seen in NDCD as compared to CCD (p < 0.001 in both). Commonly enumerated extraintestinal manifestations in NDCD included failure to thrive [109 (56.8 %)], isolated short stature [36 (18.8 %)], persistent anemia [83 (43.2 %)] and hepatomegaly/splenomegaly or both [56 (29.2 %)]. Associated comorbidities included autoimmune thyroiditis [11 (5.7 %)], type 1 diabetes mellitus [8 (4.2 %)], bronchial asthma [23 (11.9 %)], idiopathic pulmonary hemosiderosis [4 (2.1 %)], Down's syndrome [3 (1.6 %)], alopecia areata [6 (3.1 %)], polyarthritis [2 (1.0 %)], dermatitis herpetiformis [6 (3.1 %)] and chronic liver disease [6 (3.1 %)]. The number of patients with a Marsh score IIIb and above of duodenal biopsy was significantly more in the CCD group (p < 0.001). CONCLUSIONS NDCD is not uncommon in India. Long-term follow up is needed to evaluate the impact of the disease and of treatment in these children.
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Affiliation(s)
- Malobika Bhattacharya
- Department of Pediatrics, Maulana Azad Medical College and Lok Nayak Hospital, New Delhi 110 002, India.
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Sankararaman S. The importance of evaluation of Celiac disease in patients with pulmonary hemosiderosis. J La State Med Soc 2013; 165:57. [PMID: 23550401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
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Abstract
A woman over 70 years of age presented with anemia and appetite loss. She had no history of blood transfusions, although she had been receiving iron infusions for anemia for seven years. She had an elevated serum ferritin level (7,951 ng/mL) one month before admission. Abdominal computed tomography showed increased hepatic density and echocardiography showed normal heart valves and heart-wall motion. The patient eventually experienced atrial tachycardia and atrial fibrillation and died of heart failure. An autopsy revealed iron deposits in the liver, pancreas, adrenal glands, thyroid gland, gastric mucosa and myocardium. Iron-overload cardiomyopathy was diagnosed based on the iron deposits, myocardial disarray and interstitial fibrosis.
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