Idiopathic pulmonary haemosiderosis: an Oriental experience.
OBJECTIVE
Idiopathic pulmonary haemosiderosis (IPH) is a rare but potentially lethal disorder. A retrospective analysis of documented cases of IPH in our hospital was conducted in order to study the clinical spectrum and radiographic features, and to explore therapeutic strategies.


METHODS
A retrospective chart review was carried out, collecting medical records of patients with pulmonary haemo-siderosis at Chang Gung Children's Hospital (CGCH), a tertiary children's hospital in northern Taiwan. Secondary causes of pulmonary haemosiderosis were excluded.


RESULTS
Five patients were diagnosed as having IPH over a 25-year period. The classical triad of IPH was found at initial presentation in only 2/5 patients. One patient had well-established pulmonary fibrosis, but no pulmonary symptoms. The clinical course of IPH was exceedingly variable, with a mean delay of 9 months before diagnosis was made. Bronchoalveolar lavage (BAL) confirmed IPH in 3/5 patients. Immunological abnormalities were noted in two patients, without progression to immune disorders during follow up. While using corticosteroids alone, 4/5 patients continued to have recurrent bleeding episodes. All five patients required immunosuppressive therapy for maintenance of a symptom-free period, but survived to a mean follow up of 2 years.


CONCLUSIONS
Early definitive diagnosis and aggressive immunosuppressive therapy of IPH are imperative in order to avoid pulmonary fibrosis and mortality in IPH. A chest radiograph should be included in a serial work-up of unexplained anaemia in children. An examination using BAL can confirm IPH and high-resolution thoracic computed tomography scans are useful for early detection of pulmonary fibrosis.
Yao
T-C
TC
Department of Pediatrics, Chang Gung Children's Hospital, Taoyuan, Taiwan.
Hung
I-J
IJ
Wong
K-S
KS
Huang
J-L
JL
Niu
C-K
CK
D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D018798:Anemia, Iron-Deficiency; D002675:Child, Preschool; D005260:Female; D006486:Hemosiderosis / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000276:immunology / Q000503:physiopathology*; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D007223:Infant; D008171:Lung Diseases / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000276:immunology / Q000503:physiopathology*; D008297:Male; D008485:Medical Audit; D011859:Radiography; D012189:Retrospective Studies; D013624:Taiwan
D000305:Adrenal Cortex Hormones; D007166:Immunosuppressive Agents