title: Early pulmonary involvement in Niemann-Pick type B disease: lung lavage is not useful.
abstract: Niemann-Pick disease (NPD) is a rare, autosomal-recessively inherited lipid storage disease which is characterized by intracellular deposition of sphingomyelin in various body tissues. The disease is heterogeneous and classified into six groups. Pulmonary parenchymal involvement may be a feature of several subtypes of NPD, including type B. Progressive pulmonary involvement in NPD type B is a major cause of morbidity and mortality. It is usually diagnosed at older ages. Only a few cases with early pulmonary involvement have been reported. In this report, a patient with NPD type B, hospitalized with the diagnosis of pneumonia at age 3 months, is presented. Following treatment for pneumonia, she continued to have persistent respiratory symptoms and became oxygen-dependent. High-resolution computed tomography of the chest revealed diffuse interstitial changes. During follow-up, the patient developed hepatosplenomegaly. Lung, liver, and bone marrow biopsies showed characteristic findings for NPD. Biochemical studies also confirmed the diagnosis, and the sphingomyelinase enzyme level of the patient was low. Unilateral lung lavage was performed in order to decrease lipid storage as a treatment modality. However, there was no clinical or radiological improvement. The patient died at age 15 months due to progressive respiratory failure. Pulmonary involvement is a rare entity in early childhood in patients with NPD type B, but should be considered in the differential diagnosis of persistent interstitial lung disease. It may cause progressive respiratory failure, but the treatment options remain limited.
authors.affiliation: Division of Pediatric Pulmonology, Marmara University, Istanbul, Turkey. zeynepsedau@yahoo.com
authors.forename: Z S
authors.initials: ZS
authors.lastname: Uyan
authors.forename: B
authors.initials: B
authors.lastname: Karadağ
authors.forename: R
authors.initials: R
authors.lastname: Ersu
authors.forename: G
authors.initials: G
authors.lastname: Kiyan
authors.forename: E
authors.initials: E
authors.lastname: Kotiloğlu
authors.forename: S
authors.initials: S
authors.lastname: Sirvanci
authors.forename: Feriha
authors.initials: F
authors.lastname: Ercan
authors.forename: T
authors.initials: T
authors.lastname: Dağli
authors.forename: F
authors.initials: F
authors.lastname: Karakoç
authors.forename: E
authors.initials: E
authors.lastname: Dağli
mesh_terms: D018893:Bronchoalveolar Lavage; D017809:Fatal Outcome; D005260:Female; D006801:Humans; D007223:Infant; D017563:Lung Diseases, Interstitial / Q000175:diagnosis / Q000209:etiology*; D009542:Niemann-Pick Diseases / Q000150:complications*; D012131:Respiratory Insufficiency; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed