Ahmed Minhajuddin, Raj Dinesh, Kumar Ashwini, Kumar Abhay
Department of Pediatrics, Holy Family Hospital, New Delhi, India.
BMJ Case Rep. 2017 May 15;2017:bcr-2017-219431. doi: 10.1136/bcr-2017-219431.
We present an 8-year-old male child admitted with cough and high-grade fever for 7 days and respiratory difficulty for 2 days. There was a history of blood transfusion at 2 years of age during a respiratory illness. The child was anaemic, tachycardic, tachypnoeic and hypoxic at presentation. Chest examination revealed equal air entry with fine crackles bilaterally. Blood reports were suggestive of anaemia (haemoglobin 6.5 g/dL), leucocytosis and high C reactive protein levels. Chest radiograph revealed bilateral air space opacities involving diffuse lung fields, right more than left. Relevant microbiological workup was negative. Based on the clinical scenario and investigations, a provisional diagnosis of pulmonary haemosiderosis was kept. The patient was started on intravenous pulse methylprednisolone. Fibre-optic bronchoscopy was done following recovery from the acute event. Bronchoalveolar lavage demonstrated a significant number of haemosiderin-laden macrophages confirming pulmonary haemosiderosis.
我们报告一名8岁男童，因咳嗽、高热7天，呼吸困难2天入院。该患儿2岁患呼吸系统疾病时曾有输血史。入院时患儿贫血、心动过速、呼吸急促且缺氧。胸部检查显示双侧呼吸音均等，可闻及细湿啰音。血液检查提示贫血（血红蛋白6.5g/dL）、白细胞增多及C反应蛋白水平升高。胸部X线片显示双侧肺野弥漫性气腔模糊，右侧较左侧明显。相关微生物学检查结果为阴性。根据临床表现及检查，初步诊断为肺含铁血黄素沉着症。患者开始接受静脉注射甲泼尼龙冲击治疗。急性症状缓解后进行了纤维支气管镜检查。支气管肺泡灌洗显示大量含铁血黄素巨噬细胞，确诊为肺含铁血黄素沉着症。
