Severe iron deficiency anemia in a child with idiopathic pulmonary hemosiderosis: a case report

Area of Science:

• Pediatric Pulmonology
• Hematology
• Rare Diseases

Background:

• Idiopathic pulmonary hemosiderosis (IPH) is a rare cause of recurrent pulmonary hemorrhage.
• Iron deficiency anemia (IDA) is a common condition in children, but IPH is an uncommon etiology.
• Delayed diagnosis of IPH can lead to significant morbidity, including unnecessary treatments and transfusions.

Observation:

• A 3-year-old male presented with severe IDA, initially diagnosed and treated with multiple blood transfusions without identifying the underlying cause.
• Lung biopsy revealed hemosiderin-laden macrophages, confirming the diagnosis of IPH.
• The patient showed no response to standard-dose corticosteroid (CS) therapy (2 mg/kg/d).

Findings:

• High-dose, short-term CS treatment successfully managed two episodes of acute respiratory hemorrhage in this IPH patient.
• Standard-dose CS treatment was ineffective for this patient's IPH management.
• The case highlights the diagnostic challenge of IPH presenting solely as severe IDA.

Implications:

• IPH should be considered in the differential diagnosis of unexplained severe iron deficiency anemia in children.
• Prompt diagnosis of IPH can prevent extensive investigations and unnecessary blood transfusions.
• High-dose, short-term CS therapy may be a viable treatment option for acute respiratory hemorrhage in IPH patients refractory to standard doses.