Pulmonary hemosiderosis with normocomplementemic urticarial vasculitis in a child

Area of Science:

• Pulmonology
• Rheumatology
• Dermatology

Background:

• Urticarial vasculitis is typically associated with hypocomplementemia.
• Pulmonary hemosiderosis is a rare condition characterized by iron deposition in the lungs.

Observation:

• An 8-year-old girl presented with chronic urticarial lesions, conjunctivitis, cough, and hemoptysis.
• Skin biopsy confirmed leukocytoclastic vasculitis, but rheumatological markers and complement levels (C3, C4) were normal.
• Chest imaging revealed diffuse alveolar infiltrates and ground-glass opacities, with bronchoalveolar lavage showing hemosiderin-laden macrophages.

Findings:

• Systemic corticosteroids led to resolution of pulmonary symptoms, but skin and conjunctival manifestations persisted.
• Follow-up CT scans showed residual ground-glass opacities and pleural nodules, suggesting ongoing low-grade inflammation.
• This case demonstrates a rare association between urticarial vasculitis and pulmonary hemosiderosis in a normocomplementemic patient.

Implications:

• This case expands the understanding of urticarial vasculitis and pulmonary hemosiderosis associations.
• It suggests that pulmonary involvement in urticarial vasculitis can occur even with normal complement levels.
• Further research is needed to elucidate the mechanisms underlying this rare association.