Anemia of unknown etiology in a young child: Pulmonary hemosiderosis the real culprit

Abstract

Pulmonary hemosiderosis (PH) is characterized by a triad of iron-deficiency anemia, hemoptysis, and pulmonary infiltrates. We report a case of idiopathic PH diagnosed in a 6-year-old female child who initially presented with anemia of unknown etiology for about 2 years, with all the workups for the etiology of anemia being negative. When she presented to us, she had severe respiratory distress with hemoptysis. Chest X-ray showed diffuse infiltrates. Contrast-enhanced computed tomography showed ground-glass opacity. Bronchoalveolar lavage and lung cryobiopsy were performed, which showed hemosiderin-laden macrophages and confirmed the diagnosis of PH. After exclusion of cardiac, infective, immunological, and glomerular causes, a diagnosis of idiopathic PH was made. The child had recurrent exacerbations of lower respiratory tract infection thereafter, hence started on steroid inhalers. Even after starting inhalers, recurrent episodes continued and hence changed to oral steroids. Now, the frequency of episodes reduced, and the child had good symptom control.