Abstract
BackgroundIdiopathic pulmonary hemosiderosis (IPH) is a rare cause of alveolar hemorrhage in children and its pathophysiology remains obscure. Classically, diagnosis is based on a triad including hemoptysis, diffuse parenchymal infiltrates on chest X-rays, and iron-deficiency anemia. We present the French pediatric cohort of IPH collected through the French Reference Center for Rare Lung Diseases (RespiRare®, http://www.respirare.fr).MethodsSince 2008, a national network/web-linked RespiRare® database has been set up in 12 French pediatric respiratory centres. It is structured as a medical recording tool with extended disease-specific datasets containing clinical information relevant to all forms of rare lung diseases including IPH.ResultsWe identified 25 reported cases of IPH in children from the database (20 females and 5 males). Among them, 5 presented with Down syndrome. Upon diagnosis, median age was 4.3 [0.8-14.0] yrs, and the main manifestations were: dyspnea (n = 17, 68%), anemia (n = 16, 64%), cough (n = 12, 48%), febrile pneumonia (n = 11, 44%) and hemoptysis (n = 11, 44%). Half of the patients demonstrated diffuse parenchymal infiltrates on chest imaging, and diagnosis was ascertained either by broncho-alveolar lavage indicating the presence of hemosiderin-laden macrophages (19/25 cases), or lung biopsy (6/25). In screened patients, initial auto-immune screening revealed positive antineutrophilic cytoplasmic antibodies (ANCA) (n = 6, 40%), antinuclear antibodies (ANA) (n = 5, 45%) and specific coeliac disease antibodies (n = 4, 28%). All the patients were initially treated by corticosteroids. In 13 cases, immunosuppressants were introduced due to corticoresistance and/or major side effects. Median length of follow-up was 5.5 yrs, with a satisfactory respiratory outcome in 23/25 patients. One patient developed severe pulmonary fibrosis, and another with Down syndrome died as a result of severe pulmonary hemorrhage.ConclusionThe present cohort provides substantial information on clinical expression and outcomes of pediatric IPH. Analysis of potential contributors supports a role of auto-immunity in disease development and highlights the importance of genetic factors.
Highlights
Idiopathic pulmonary hemosiderosis (IPH) is a rare cause of alveolar hemorrhage of unknown etiology in children, leading to chronic infiltrative pulmonary disease [1,2,3,4]
Through the organization of the French Reference Center for Rare Lung Diseases (RespiRare®) with the national network/web-linked database, we reviewed the IPH cases in the French pediatric population with two main goals: to update management strategies and to provide new insights into disease contributors and physiopathology [24]
Material and methods Since 2008, the RespiRare® database has been set up in 12 French pediatric respiratory centres. This database is structured as a medical recording tool for the patient, with extended disease-specific datasets containing clinical information relevant to all kinds of rare lung diseases including interstitial lung disease and IPH [24]
Summary
Idiopathic pulmonary hemosiderosis (IPH) is a rare cause of alveolar hemorrhage of unknown etiology in children, leading to chronic infiltrative pulmonary disease [1,2,3,4]. It is classically characterized by a triad of hemoptysis, iron-deficiency anemia and pulmonary infiltrates on chest X-rays; and usually occurs before the age of 10 years (yrs) old [5,6,7,8,9,10]. Diagnosis is based on a triad including hemoptysis, diffuse parenchymal infiltrates on chest X-rays, and iron-deficiency anemia. We present the French pediatric cohort of IPH collected through the French Reference Center for Rare Lung Diseases (RespiRare®, www.respirare.fr)
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