Recurrent diffuse pulmonary hemorrhage with minor kidney lesions.

Area of Science:

• Pulmonology
• Nephrology
• Immunology

Background:

• A 14-year-old male presented with a 3-month history of dyspnea and iron deficiency anemia.
• Admission findings included hemoptysis and bilateral pulmonary shadows, suggesting significant respiratory compromise.

Observation:

• Transbronchial lung biopsies revealed linear immunoglobulin G (IgG) and complement 3 (C3) deposits in the alveolar basement membrane.
• Serum and kidney biopsies were negative for anti-glomerular basement membrane (anti-GBM) antibodies.
• An elevated T helper/T suppressor (T4/T8) cell ratio of 5 was noted in peripheral blood.

Findings:

• The patient received prednisolone and cyclophosphamide, leading to temporary cessation of pulmonary bleeding.
• Recurrent hemoptysis necessitated plasma exchange, which proved successful in controlling the bleeding.

Implications:

• This case highlights a potential autoimmune pulmonary hemorrhage in a pediatric patient.
• The findings suggest a possible role for T-cell dysregulation in the pathogenesis.
• Successful management involved a combination of immunosuppression and plasma exchange.