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Looking beyond the obvious: an unusual cause of iron deficiency anaemia
C S Jyotirmanju1, P Mallya1, Aarthi Rau2
1Department of Pediatrics, M.S. Ramaiah Medical College, Bangalore, 560054 India.
Insights
Iron deficiency anemia in children can stem from rare causes beyond poor diet. This case highlights Systemic Lupus Erythematosus (SLE) triggering alveolar hemorrhage, a critical diagnosis for effective treatment.
Area of Science:
- Pediatric Hematology
- Pulmonary Medicine
- Rheumatology
Background:
- Iron deficiency anemia (IDA) is the most prevalent hematological disorder in childhood.
- While dietary iron deficiency is common, other underlying causes must be investigated.
- Recurrent respiratory infections and pulmonary infiltrates can complicate pediatric IDA.
Observation:
- A 5-year-old girl presented with severe IDA, recurrent chest infections, and bilateral pulmonary infiltrates.
- She showed no improvement with antibiotics, anti-tuberculosis therapy, or iron supplementation.
- Lung biopsy revealed intra-alveolar blood and hemosiderin-laden macrophages.
Findings:
- Further investigations confirmed Systemic Lupus Erythematosus (SLE) with positive anti-dsDNA antibodies.
- The clinical presentation and biopsy findings led to the diagnosis of SLE-induced alveolar hemorrhage.
- Glucocorticoid therapy was initiated for the patient.
Implications:
- This case underscores the importance of considering autoimmune diseases like SLE in pediatric IDA with pulmonary involvement.
- Prompt diagnosis and initiation of immunosuppressive therapy are crucial for managing SLE-induced alveolar hemorrhage.
- Early intervention can lead to favorable outcomes, as demonstrated by the patient's positive response to glucocorticoids.
Abstract:
Iron deficiency anaemia (IDA) is the most common haematological disorder seen in childhood. While poor intake of iron is the most common cause of IDA, a diligent search must be made to exclude other causes. We present a 5 year old girl who had recurrent hospital admissions for chest infection, radiographic evidence of bilateral pulmonary infiltrates and severe IDA. When she failed to respond to repeated courses of antibiotics, anti tubercular and parenteral and oral iron therapy, a lung biopsy was done which revealed blood and hemosiderophages within the alveoli. Further investigations were suggestive of SLE (dsDNA positivity). A diagnosis of SLE induced alveolar haemorrhage was made and therapy with glucocorticoids was initiated. She has responded well to therapy.
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