Yang Jing, Gou Ruo Yan, Ding Xia, Shao Li Li, Ma Gui Xia, Ni Qian
Department of Pediatrics, Lanzhou University Second Hospital, Lanzhou, China.
Respir Med Case Rep. 2022 Feb 24;36:101610. doi: 10.1016/j.rmcr.2022.101610. eCollection 2022.
Idiopathic pulmonary hemosiderosis (IPH) is a rare cause of diffuse alveolar hemorrhage (DAH) with unknown etiology. Hemoptysis, dyspnea, anemia, diffuse infiltration in chest radiography and presence of hemosiderin-loaded macrophages (HLMs) in the sputum, gastric content or bronchoalveolar lavage fluid (BALF) are the major characteristics for diagnosis of IPH. Here we present two pediatric patients with IPH. Patient 1 was repeatly misdiagnosed with bronchopneumonia because of diffuse infiltration in her chest X ray, but her anemia was repeatedly ignored. Patient 2 was misdiagnosed with nutritional anaemia because she did not have dyspnea or hemoptysis, and her chest computed tomography (CT) only revealed mild alveolar infiltrates. IPH must be included in the differential diagnosis in patients with long-term anemia who respond poorly to the hematopoietic supplements. CT is superior to X-ray in detecting alveolar hemorrhage.
特发性肺含铁血黄素沉着症（IPH）是弥漫性肺泡出血（DAH）的一种罕见病因，病因不明。咯血、呼吸困难、贫血、胸部X线片上的弥漫性浸润以及痰液、胃内容物或支气管肺泡灌洗液（BALF）中存在含铁血黄素巨噬细胞（HLM）是IPH诊断的主要特征。在此，我们报告两名患有IPH的儿科患者。患者1因胸部X线片上的弥漫性浸润而多次被误诊为支气管肺炎，但其贫血却一再被忽视。患者2因没有呼吸困难或咯血，且其胸部计算机断层扫描（CT）仅显示轻度肺泡浸润而被误诊为营养性贫血。对于长期贫血且对造血补充剂反应不佳的患者，鉴别诊断中必须考虑IPH。在检测肺泡出血方面，CT优于X线。
