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Jaramillo C, Ferguson E, Odisio E, Ocazionez D. High-density pulmonary lesions: Review in chest imaging. Curr Probl Diagn Radiol 2024:S0363-0188(24)00117-8. [PMID: 39019711 DOI: 10.1067/j.cpradiol.2024.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2024] [Accepted: 07/08/2024] [Indexed: 07/19/2024]
Abstract
High-density pulmonary lesions are frequently seen in chest imaging, and it is important to identify their different causes. Radiologists must be able to distinguish between common and rare conditions in order to provide the best diagnosis and treatment. This article provides an overview of the various causes and imaging features of high-density lesions in the lungs. The lesions are classified into various categories, such as pulmonary nodules, inflammatory conditions, deposition diseases, contrast-related lesions, and thoracic devices. A clear understanding of these categories can help radiologists accurately diagnose and manage high-density pulmonary lesions encountered in practice.
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Affiliation(s)
- Catalina Jaramillo
- University of Texas Health Science Center at Houston, Department of Diagnostic & Interventional Imaging, 7000 Fannin St, Houston, TX, 77030.
| | - Emma Ferguson
- University of Texas Health Science Center at Houston, Department of Diagnostic & Interventional Imaging, 7000 Fannin St, Houston, TX, 77030
| | - Erika Odisio
- University of Texas Health Science Center at Houston, Department of Diagnostic & Interventional Imaging, 7000 Fannin St, Houston, TX, 77030
| | - Daniel Ocazionez
- University of Texas Health Science Center at Houston, Department of Diagnostic & Interventional Imaging, 7000 Fannin St, Houston, TX, 77030
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2
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Uejima Y, Yoshida K, Ohashi H. Idiopathic pulmonary hemosiderosis associated with Kabuki syndrome. Immunol Med 2024:1-3. [PMID: 38916243 DOI: 10.1080/25785826.2024.2370937] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2024] [Accepted: 06/18/2024] [Indexed: 06/26/2024] Open
Abstract
Kabuki syndrome (KS) is a genetic disorder caused by gene mutations in either lysine-specific methyltransferase 2D (KMT2D) or lysine demethylase 6A (KDM6A). This congenital disorder exhibits characteristic facial features, developmental delays in psychomotor skills, and skeletal abnormalities. Moreover, it is classified as a congenital immunodeficient disorder under the category of combined immunodeficiency, leading to hypogammaglobulinemia and the onset of autoimmune diseases. Here, we present the first case of KS complicated by idiopathic pulmonary hemosiderosis (IPH). The KS patient, a 2-year-old Japanese girl with a history of hypoplastic left heart syndrome and recurrent bacterial infection, developed severe respiratory distress and anemia. She had autoimmune hemolytic anemia and gouty nephropathy. Hemophagocytic macrophages with hemosiderin ingestion were identified in bronchoalveolar lavage fluid, excluding differential diagnoses and leading to the diagnosis of idiopathic pulmonary hemosiderosis. Intravenous prednisolone (2 mg/kg/day) was administered, but symptoms did not improve. However, pulmonary hemorrhage disappeared with methylprednisolone pulse therapy. IPH warrants consideration in cases where individuals with KS manifest idiopathic pneumonia and concurrent anemia.
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Affiliation(s)
- Yoji Uejima
- Division of Infectious Diseases and Immunology, Saitama Children's Medical Center, Saitama, Japan
| | - Kenji Yoshida
- Department of Pediatric Cardiology, Saitama Children's Medical Center, Saitama, Japan
| | - Hirofumi Ohashi
- Division of Medical Genetics, Saitama Children's Medical Center, Saitama, Japan
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3
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Huang Z, Cheng T, Chen G. Pulmonary siderosis complicated with severe mycoplasma pneumoniae pneumonia: A case report. Respir Med Case Rep 2024; 48:101996. [PMID: 38426012 PMCID: PMC10904270 DOI: 10.1016/j.rmcr.2024.101996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Revised: 02/05/2024] [Accepted: 02/16/2024] [Indexed: 03/02/2024] Open
Abstract
Idiopathic pulmonary hemosiderosis (IPH) is a rare and fatal lung disease. Mycoplasma pneumoniae pneumonia (MPP) is the main community-acquired pneumonia among children aged 5 and above in China. We report the following case of IPH complicated with severe mycoplasma pneumoniae pneumonia(SMPP). An 8-year-old boy with cough and fever was diagnosed with IPH for 3 years and his chest computed tomography showed bilateral bronchopneumonia, lobular consolidation and subpleural interstitial fibrosis. As far as we know, IPH related to SMPP is rarely reported. In the high incidence period of MPP, clinicians and radiologists should be alert to the co-occurrence of IPH and SMPP.
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Affiliation(s)
- Zhen Huang
- Department of Radiology, Chengdu Second People's Hospital, Chengdu, Sichuan, China
- School of Medicine and Life Sciences, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
| | - Tao Cheng
- Department of Radiology, Chengdu Second People's Hospital, Chengdu, Sichuan, China
| | - Guangwen Chen
- Department of Radiology, Chengdu Second People's Hospital, Chengdu, Sichuan, China
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4
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Milutinovic S, Jancic P, Adam A, Radovanovic M, Nordstrom CW, Ward M, Petrovic M, Jevtic D, Delibasic M, Kotseva M, Nikolajevic M, Dumic I. Cardiomyopathy in Celiac Disease: A Systematic Review. J Clin Med 2024; 13:1045. [PMID: 38398359 PMCID: PMC10889265 DOI: 10.3390/jcm13041045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Revised: 02/05/2024] [Accepted: 02/08/2024] [Indexed: 02/25/2024] Open
Abstract
(1) Background: Cardiomyopathy in celiac disease or celiac cardiomyopathy (CCM) is a serious and potentially life-threatening disease that can occur in both adults and children. However, data supporting the causal relationship between celiac disease (CD) and cardiomyopathy (CMP) are still inconsistent. The aim of this study was to review and synthesize data from the literature on this topic and potentially reveal a more evidence-based causal relationship. (2) Methods: The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were used to search Medline, Embase, and Scopus databases from database inception until September 2023. A total of 1187 original articles were identified. (3) Results: We identified 28 CCM patients (19 adult and 9 pediatric) with a mean age of 27.4 ± 18.01 years. Adult patients with CCM were predominantly male (84.2%) while pediatric patients were predominantly female (75%). The most common comorbidities associated with CCM were anemia (75%) and pulmonary hemosiderosis (20%). In 35% of patients, CCM occurred before the diagnosis of CD, while in 48% of patients, CCM and CD were diagnosed at the same time. Diagnosis of CD preceded diagnosis of CCM in only 18% of patients. Diagnosis of CCM is often delayed with an average, from the onset of symptoms to diagnosis, of 16 months. All patients were treated with a gluten-free diet in addition to guideline-directed medical therapy. At 11-month follow-up, cardiovascular improvement was seen in 60.7% of patients. Pediatric mortality was 33.3%, while adult mortality was 5.3%. (4) Conclusions: Clinicians should be aware of the possible association between CD and CMP, and we recommend CD work-up in all patients with CMP who have concomitant anemia. While we identified only 28 cases in the literature, many cases might go unreported due to a lack of awareness regarding CCM. A high degree of clinical suspicion and a prompt diagnosis of CCM are essential to minimizing the risks of morbidity and mortality, as the combination of a gluten-free diet and guideline-directed medical therapy can improve clinical outcomes.
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Affiliation(s)
- Stefan Milutinovic
- Internal Medicine Residency Program at Lee Health, Florida State University College of Medicine, Tallahassee, FL 32301, USA; (S.M.); (M.D.)
| | - Predrag Jancic
- School of Medicine, University of Belgrade, 11000 Belgrade, Serbia; (P.J.); (M.N.)
| | - Adam Adam
- Cardiology Fellowship Program, Cook County, Chicago, IL 60612, USA;
| | - Milan Radovanovic
- Section of Hospital Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, NH 03766, USA; (M.R.); (M.W.)
- Mayo Clinic College of Medicine and Science, Rochester, MN 55905, USA;
- Department of Hospital Medicine, Mayo Clinic Health System, Eau Claire, WI 54703, USA
| | - Charles W. Nordstrom
- Mayo Clinic College of Medicine and Science, Rochester, MN 55905, USA;
- Department of Hospital Medicine, Mayo Clinic Health System, Eau Claire, WI 54703, USA
| | - Marshall Ward
- Section of Hospital Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, NH 03766, USA; (M.R.); (M.W.)
| | - Marija Petrovic
- Cardiology Fellowship Program, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA;
| | | | - Maja Delibasic
- Internal Medicine Residency Program at Lee Health, Florida State University College of Medicine, Tallahassee, FL 32301, USA; (S.M.); (M.D.)
| | | | - Milan Nikolajevic
- School of Medicine, University of Belgrade, 11000 Belgrade, Serbia; (P.J.); (M.N.)
| | - Igor Dumic
- Mayo Clinic College of Medicine and Science, Rochester, MN 55905, USA;
- Department of Hospital Medicine, Mayo Clinic Health System, Eau Claire, WI 54703, USA
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5
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Kono M, Oshima Y, Katsumata M, Hirama R, Takeda K, Mochizuka Y, Tsutsumi A, Miwa H, Miki Y, Hashimoto D, Otsuki Y, Suda T, Nakamura H. An Adult Case of Idiopathic Pulmonary Hemosiderosis Associated with Pulmonary Fibrosis and Emphysematous Change. Intern Med 2024; 63:119-124. [PMID: 37225487 PMCID: PMC10824645 DOI: 10.2169/internalmedicine.1663-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Accepted: 04/11/2023] [Indexed: 05/26/2023] Open
Abstract
A 48-year-old woman was admitted to our hospital with acute respiratory failure. Chest computed tomography showed ground-glass opacity and patchy emphysematous lesions in both lungs. Corticosteroid therapy was effective; however, the disease worsened with the tapering of corticosteroids. Bronchoalveolar lavage revealed hemosiderin-laden macrophages, and video-assisted thoracic surgery showed diffuse interstitial fibrosis with diffuse alveolar hemorrhage (DAH). There was no evidence of vasculitis nor autoimmune diseases. This patient was diagnosed with idiopathic pulmonary hemosiderosis (IPH) that progressed to end-stage pulmonary fibrosis despite treatment. Autopsy demonstrated DAH with pulmonary fibrosis and emphysematous change, suggesting IPH-related pulmonary lesions.
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Affiliation(s)
- Masato Kono
- Department of Respiratory Medicine, Seirei Hamamatsu General Hospital, Japan
| | - Yuiko Oshima
- Department of Respiratory Medicine, Seirei Hamamatsu General Hospital, Japan
| | - Megumi Katsumata
- Department of Respiratory Medicine, Seirei Hamamatsu General Hospital, Japan
| | - Ryutaro Hirama
- Department of Respiratory Medicine, Seirei Hamamatsu General Hospital, Japan
| | - Kenichiro Takeda
- Department of Respiratory Medicine, Seirei Hamamatsu General Hospital, Japan
| | - Yasutaka Mochizuka
- Department of Respiratory Medicine, Seirei Hamamatsu General Hospital, Japan
| | - Akari Tsutsumi
- Department of Respiratory Medicine, Seirei Hamamatsu General Hospital, Japan
| | - Hideki Miwa
- Department of Respiratory Medicine, Seirei Hamamatsu General Hospital, Japan
| | - Yoshihiro Miki
- Department of Respiratory Medicine, Seirei Hamamatsu General Hospital, Japan
| | - Dai Hashimoto
- Department of Respiratory Medicine, Seirei Hamamatsu General Hospital, Japan
| | - Yoshiro Otsuki
- Department of Pathology, Seirei Hamamatsu General Hospital, Japan
| | - Takafumi Suda
- Second Division, Department of Internal Medicine, Hamamatsu University School of Medicine, Japan
| | - Hidenori Nakamura
- Department of Respiratory Medicine, Seirei Hamamatsu General Hospital, Japan
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Guo S, Yin J, Yao Y, Chen L, Wang H, Zhao Z, Xu B, Liu X. Juvenile idiopathic arthritis presenting as diffuse alveolar hemorrhage at onset: A case series. Pediatr Pulmonol 2023; 58:3040-3045. [PMID: 37144854 DOI: 10.1002/ppul.26455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Revised: 04/15/2023] [Accepted: 04/20/2023] [Indexed: 05/06/2023]
Abstract
OBJECTIVE The etiology of diffuse alveolar hemorrhage (DAH) in childhood is often unknown, and it may be an early manifestation of rheumatic disease. Juvenile idiopathic arthritis (JIA) is one of the most common rheumatic diseases in children, but DAH as an onset manifestation of JIA is rare. This study summarizes the clinical characteristics of patients with JIA presenting as DAH. METHODS We retrospectively analyzed the age of onset, clinical manifestations, imaging features, treatments, and prognosis of five cases of JIA presenting as DAH. RESULTS Themedian age at DAH onset was 6 months (range, 2 months-3 years). Pallor was the most common manifestation of onset (5/5). Other symptoms included cough (2/5), tachypnea (2/5), hemoptysis (1/5), cyanosis (1/5), and fatigue (1/5). Imaging showed ground-glass opacity (GGO) (5/5), subpleural or intrapulmonary honeycombing (4/5), consolidation (3/5), interlobular septal thickening (2/5), and nodules (1/5). Anticitrullinated protein antibodies (ACPA) and rheumatoid factor (RF) were positive in five children (5/5), and antinuclear antibody (ANA) was positive in four children (4/5). ANA in three children and ACPA/RF in one child were positive before the onset of joint symptoms. The median age at the onset of joint symptoms was 3 years and 9 months (2 years and 6 months-8 years). Joint symptoms were mainly characterized by joint swelling, pain, and difficulty walking, and the most commonly affected joints were the knees, ankles, and wrists. After the diagnosis of DAH, the five patients were treated with glucocorticoids. Alveolar hemorrhage was effectively controlled in three cases, but the other two patients still had anemia and poor improvements in chest imaging. After joint symptoms, the patients were treated with glucocorticoids combined with diclofenac, disease-modifying antirheumatic drugs, and biological agents. Alveolar hemorrhage was in remission, and joint symptoms were relieved in the five cases. CONCLUSION DAH can be the first clinical manifestation of JIA, and joint involvement occurs 1-5 years later. Children with DAH who are positive for RF, ACPA, and/or ANA and have GGO accompanied by honeycombing on imaging should be concerned about their joint involvement in future.
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Affiliation(s)
- Siyuan Guo
- Department of Respiratory Medicine, National Clinical Research Center for Respiratory Diseases, National Center for Children's Health, Beijing Children's Hospital, Capital Medical University, Beijing, China
| | - Ju Yin
- Department of Respiratory Medicine, National Clinical Research Center for Respiratory Diseases, National Center for Children's Health, Beijing Children's Hospital, Capital Medical University, Beijing, China
| | - Yao Yao
- Department of Respiratory Medicine, National Clinical Research Center for Respiratory Diseases, National Center for Children's Health, Beijing Children's Hospital, Capital Medical University, Beijing, China
| | - Lanqin Chen
- Department of Respiratory Medicine, National Clinical Research Center for Respiratory Diseases, National Center for Children's Health, Beijing Children's Hospital, Capital Medical University, Beijing, China
| | - Hao Wang
- Department of Respiratory Medicine, National Clinical Research Center for Respiratory Diseases, National Center for Children's Health, Beijing Children's Hospital, Capital Medical University, Beijing, China
| | - Zhipeng Zhao
- Department of Respiratory Medicine, National Clinical Research Center for Respiratory Diseases, National Center for Children's Health, Beijing Children's Hospital, Capital Medical University, Beijing, China
| | - Baoping Xu
- Department of Respiratory Medicine, National Clinical Research Center for Respiratory Diseases, National Center for Children's Health, Beijing Children's Hospital, Capital Medical University, Beijing, China
| | - Xiuyun Liu
- Department of Respiratory Medicine, National Clinical Research Center for Respiratory Diseases, National Center for Children's Health, Beijing Children's Hospital, Capital Medical University, Beijing, China
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Crowe O, Maiorella R, Tanimoto A, Patel SJ. Anemia and a New Supplemental Oxygen Requirement in a 2-year-old Boy. Pediatr Rev 2023; 44:S81-S84. [PMID: 37777222 DOI: 10.1542/pir.2022-005663] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/02/2023]
Affiliation(s)
- Olivia Crowe
- Department of Pediatrics, University of Cincinnati, and Cincinnati Children's Hospital, Cincinnati, OH
| | - RosaMarie Maiorella
- Division of Hospital Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
- Department of Pediatrics, University of Cincinnati, College of Medicine, Cincinnati, OH
| | - Aki Tanimoto
- Department of Pediatrics, University of Cincinnati, College of Medicine, Cincinnati, OH
- Department of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Shivani J Patel
- Division of Hospital Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
- Department of Pediatrics, University of Cincinnati, College of Medicine, Cincinnati, OH
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8
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Ma X, Ju C, Liu X, Tian Y, Wu J, Li Y. Idiopathic pulmonary haemosiderosis misdiagnosed as haemolytic anaemia: a case report. J Int Med Res 2023; 51:3000605231210402. [PMID: 37903315 PMCID: PMC10617271 DOI: 10.1177/03000605231210402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Accepted: 10/11/2023] [Indexed: 11/01/2023] Open
Abstract
Idiopathic pulmonary haemosiderosis is a rare disease primarily affecting children. The condition is characterized by widespread bleeding from alveolar capillaries, resulting in symptoms such as haemoptysis, shortness of breath and iron deficiency anaemia. However, it is not a specific disease and sometimes can manifest solely as anaemia, which may be easily overlooked and misdiagnosed. The purpose of this case report was to describe a 1-year-old boy who exhibited haemolytic anaemia as the only symptom of idiopathic pulmonary haemosiderosis, with the intention of offering clinical insights into the precise diagnosis and subsequent management of this rare and easily misdiagnosed disease. Clinicians should keep idiopathic pulmonary haemosiderosis in mind when evaluating children with haemolytic anaemia and promptly initiate testing and treatment to prevent misdiagnosis and improve outcomes.
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Affiliation(s)
- Xueqin Ma
- Department of Clinical Medicine, Lanzhou University Second Hospital, Lanzhou, Gansu Province, China
| | - Changxi Ju
- Department of Clinical Medicine, Lanzhou University Second Hospital, Lanzhou, Gansu Province, China
| | - Xiaotong Liu
- Department of Clinical Medicine, Lanzhou University Second Hospital, Lanzhou, Gansu Province, China
| | - Ying Tian
- West China School of Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China
| | - Jing Wu
- Department of Paediatric Intensive Care Medicine, Lanzhou University Second Hospital, Lanzhou, Gansu Province, China
| | - Yuanxiao Li
- Department of Paediatric Gastroenterology, Lanzhou University Second Hospital, Lanzhou, Gansu Province, China
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9
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Mopeli K, Mabaso T, Alli N, Dangor Z, Verwey C. Diffuse alveolar haemorrhage in children hospitalised in a tertiary‑level hospital: A retrospective descriptive study. Afr J Thorac Crit Care Med 2023; 29:10.7196/AJTCCM.2023.v29i2.282. [PMID: 37622106 PMCID: PMC10446159 DOI: 10.7196/ajtccm.2023.v29i2.282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Accepted: 05/03/2023] [Indexed: 08/26/2023] Open
Abstract
Background Diffuse alveolar haemorrhage (DAH) is considered a rare condition in children. There is no consensus on the management of DAH syndromes in Africa or other low- and middle-income countries. In this brief report, the clinical characteristics, management and outcomes of children treated for DAH in the Chris Hani Baragwanath Academic Hospital paediatric pulmonology unit in Johannesburg, South Africa are described. Fifteen children were included in this case series, of whom 11 (73.3%) presented with severe microcytic anaemia. Of the 11 children who had bronchoalveolar lavage, 9 (81.8%; 60.0% of the total) had haemosiderin-laden macrophages on microscopy. Only 5 children had a lung biopsy, of whom 3 (60.0%) had capillaritis. All the children were started on oral prednisone at presentation, and 11 (73.3%) received additional complementary treatment. Nine children (60.0%) had normal haemoglobin levels 1 year after initiation of treatment. Our series supports previous reports that DAH is uncommon in children. A large proportion of our patients responded well to treatment despite some resource limitations. What the study adds The study provides additional data on children presenting with diffuse alveolar haemorrhage in a South African tertiary hospital. What are the implications of the findings There is a need for South African pulmonologists to come together and conduct a national audit of these patients in different hospitals to determine the incidence in our country, as well as to inform a management plan in the presence or absence of specialised tests.
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Affiliation(s)
- K Mopeli
- Department of Paediatrics and Child Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - T Mabaso
- Department of Paediatrics and Child Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - N Alli
- Department of Molecular Medicine and Haematology, School of Pathology, Faculty of Health Sciences, University of the Witwatersrand,
Johannesburg, South Africa; National Health Laboratory Service, Johannesburg, South Africa
| | - Z Dangor
- Department of Paediatrics and Child Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - C Verwey
- Department of Paediatrics and Child Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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10
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Mahendran AJ, Gupta N. A Closer Look Into a Bleeding Lung…. Chest 2023; 163:e285. [PMID: 37295888 DOI: 10.1016/j.chest.2023.02.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Accepted: 02/01/2023] [Indexed: 06/12/2023] Open
Affiliation(s)
- A J Mahendran
- Department of Pulmonary Medicine, Critical Care and Sleep Medicine, Safdarjung Hospital and Vardhaman Mahavir Medical College, New Delhi, India.
| | - Nitesh Gupta
- Department of Pulmonary Medicine, Critical Care and Sleep Medicine, Safdarjung Hospital and Vardhaman Mahavir Medical College, New Delhi, India
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Knoflach K, Rapp CK, Schwerk N, Carlens J, Wetzke M, Emiralioğlu N, Kiper N, Ring AM, Buchvald F, Manali E, Papiris S, Reu-Hofer S, Kappler M, Schieber A, Seidl E, Gothe F, Robinson PN, Griese M. Diffuse alveolar hemorrhage in children with interstitial lung disease: Determine etiologies! Pediatr Pulmonol 2023; 58:1106-1121. [PMID: 36588100 DOI: 10.1002/ppul.26301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Revised: 11/11/2022] [Accepted: 12/27/2022] [Indexed: 01/03/2023]
Abstract
OBJECTIVE Diffuse alveolar hemorrhage (DAH) in children is a rare condition resulting from different underlying diseases. This study aimed at describing characteristics and diagnostic measures in children with ILD (children's interstitial lung disease, chILD) and DAH to improve the diagnostic approach by increasing clinician's awareness of diagnostic shortcomings. PATIENTS AND METHODS A retrospective data analysis of patients with ILD and DAH treated in our own or collaborating centers between 01/07/1997 and 31/12/2020 was performed. Data on clinical courses and diagnostic measures were systematically retrieved as case-vignettes and investigated. To assess suitability of diagnostic software-algorithms, the Human Phenotype Ontology (HPO) was revised and expanded to optimize conditions of its associated tool the "Phenomizer." RESULTS For 97 (74%) of 131 patients, etiology of pulmonary hemorrhage was clarified. For 34 patients (26%), no underlying condition was found (termed as idiopathic pulmonary hemorrhage, IPH). Based on laboratory findings or clinical phenotype/comorbidities, 20 of these patients were assigned to descriptive clusters: IPH associated with autoimmune features (9), eosinophilia (5), renal disease (3) or multiorgan involvement (3). For 14 patients, no further differentiation was possible. CONCLUSION Complete and sometimes repeated diagnostics are essential for establishing the correct diagnosis in children with DAH. We suggest assignment of patients with IPH to descriptive clusters, which may also guide further research. Digital tools such as the Phenomizer/HPO are promising, but need to be extended to increase diagnostic accuracy.
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Affiliation(s)
- Katrin Knoflach
- Department of Pediatrics, Dr. von Hauner Children's Hospital, University Hospital, Ludwig-Maximilians-University (LMU) Munich, Munich, Germany
| | - Christina Katharina Rapp
- Department of Pediatrics, Dr. von Hauner Children's Hospital, University Hospital, Ludwig-Maximilians-University (LMU) Munich, Munich, Germany
| | - Nicolaus Schwerk
- Department of Pediatrics, Pediatric Pulmonology, Allergology and Neonatology, Hannover Medical School, Hannover, Germany.,German Center for Lung Research (DLZ), Partner Site Hannover (BREATH), Hanover, Germany
| | - Julia Carlens
- Department of Pediatrics, Pediatric Pulmonology, Allergology and Neonatology, Hannover Medical School, Hannover, Germany
| | - Martin Wetzke
- Department of Pediatrics, Pediatric Pulmonology, Allergology and Neonatology, Hannover Medical School, Hannover, Germany
| | - Nagehan Emiralioğlu
- Department of Pediatric Pulmonology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Nural Kiper
- Department of Pediatric Pulmonology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Astrid Madsen Ring
- Pediatric Pulmonary Service, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Frederik Buchvald
- Pediatric Pulmonary Service, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Effrosyni Manali
- Department of Respiratory Medicine, 'Attikon' University Hospital, Athens Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Spyros Papiris
- Department of Respiratory Medicine, 'Attikon' University Hospital, Athens Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Simone Reu-Hofer
- Institute of Pathology, University of Würzburg, Würzburg, Germany
| | - Matthias Kappler
- Department of Pediatrics, Dr. von Hauner Children's Hospital, University Hospital, Ludwig-Maximilians-University (LMU) Munich, Munich, Germany
| | - Alexandra Schieber
- Department of Pediatrics, Dr. von Hauner Children's Hospital, University Hospital, Ludwig-Maximilians-University (LMU) Munich, Munich, Germany
| | - Elias Seidl
- Department of Pediatrics, Dr. von Hauner Children's Hospital, University Hospital, Ludwig-Maximilians-University (LMU) Munich, Munich, Germany
| | - Florian Gothe
- Department of Pediatrics, Dr. von Hauner Children's Hospital, University Hospital, Ludwig-Maximilians-University (LMU) Munich, Munich, Germany
| | - Peter N Robinson
- The Jackson Laboratory for Genomic Medicine, Farmington, Connecticut, USA
| | - Matthias Griese
- Department of Pediatrics, Dr. von Hauner Children's Hospital, University Hospital, Ludwig-Maximilians-University (LMU) Munich, Munich, Germany.,German center for Lung Research (DLZ), Partner Site Munich, Munich, Germany
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12
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Laudelino JS, Aguiar FMB, Martins FPR, de Oliveira RL, Cruz GRCB, Ramos AL. Pulmonary hemosiderosis secondary to mitral stenosis: a case report. SURGICAL AND EXPERIMENTAL PATHOLOGY 2023. [DOI: 10.1186/s42047-023-00131-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/20/2023] Open
Abstract
Abstract
Background
Pulmonary hemosiderosis is a rare disease that may be idiopathic or have a secondary etiology, such as mitral stenosis. The disease is a clinical and functional consequence of iron overload in the lungs in the form of hemosiderin. The diagnosis should be considered in patients with miliary nodules on chest tomography.
Case presentation
We report a case of a 30-year-old man with severe mitral stenosis who presented with chest pain and dyspnea. High-resolution chest tomography showed bilateral centrilobular micronodules. The diagnosis of pulmonary hemosiderosis secondary to mitral stenosis was suggested by transbronchial biopsy.
Conclusion
The diagnosis of idiopathic pulmonary hemosiderosis requires the exclusion of other etiologies of alveolar hemorrhage, including infections and vasculitis. One possible etiology is mitral stenosis.
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13
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Gao FQ, Zhang JM, Li CF. Clinical Presentation and Treatment of Juvenile Idiopathic Arthritis Combined with Lung Disease: A Narrative Review. Rheumatol Ther 2023; 10:507-522. [PMID: 36906693 PMCID: PMC10008073 DOI: 10.1007/s40744-023-00542-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Accepted: 02/13/2023] [Indexed: 03/13/2023] Open
Abstract
Juvenile idiopathic Arthritis (JIA) is a common rheumatic disorder in children that can cause multiple systems to be affected simultaneously, leading to severe clinical symptoms and a high mortality rate in those with pulmonary involvement. Pleurisy is the most common manifestation of pulmonary involvement. At the same time, other conditions, such as pneumonia, interstitial lung disease, occlusive bronchiectasis, and alveolar protein deposition, have been increasingly reported in recent years. This review aims to provide an overview of the clinical manifestations of JIA lung damage and the current treatment options to assist in identifying and treating JIA lung involvement.
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Affiliation(s)
- Feng-Qiao Gao
- Department of Rheumatology, Beijing Children’s Hospital, Capital Medical University, National Center for Children’s Health, Nan Li Shi Road No. 56, Beijing, 100045 China
| | - Jun-Mei Zhang
- Department of Rheumatology, Beijing Children’s Hospital, Capital Medical University, National Center for Children’s Health, Nan Li Shi Road No. 56, Beijing, 100045 China
| | - Cai-Feng Li
- Department of Rheumatology, Beijing Children’s Hospital, Capital Medical University, National Center for Children’s Health, Nan Li Shi Road No. 56, Beijing, 100045 China
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14
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Nayir Buyuksahin H, Kiper N. Childhood Interstitial Lung Disease. PEDIATRIC ALLERGY, IMMUNOLOGY, AND PULMONOLOGY 2023; 36:5-15. [PMID: 36695653 DOI: 10.1089/ped.2022.0013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Childhood interstitial lung disease (chILD) is a heterogeneous group of diseases with various clinical and imaging findings. The incidence and prevalence have increased in recent years, probably due to better comprehension of these rare diseases and increased awareness among physicians. chILDs present with nonspecific pulmonary symptoms, such as tachypnea, hypoxemia, cough, rales, and failure to thrive. Unnecessary invasive procedures can be avoided if specific mutations are detected through genetic examinations or if typical imaging patterns are recognized on computed tomography. Disease knowledge and targeted therapies are improving through international collaboration. Pulmonary involvement in systemic diseases is not uncommon. Pulmonary involvement may be the first finding in connective tissue diseases. This review aims to present a systematic patient-targeted approach to the diagnosis of chILD.
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Affiliation(s)
- Halime Nayir Buyuksahin
- Department of Pediatric Pulmonology, School of Medicine, Hacettepe University, Ihsan Dogramaci Children's Hospital, Ankara, Turkey
| | - Nural Kiper
- Department of Pediatric Pulmonology, School of Medicine, Hacettepe University, Ihsan Dogramaci Children's Hospital, Ankara, Turkey
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15
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Interstitial Lung Disease and Anti-Neutrophil Cytoplasmic Antibody–Associated Vasculitis. Immunol Allergy Clin North Am 2023; 43:379-388. [PMID: 37055094 DOI: 10.1016/j.iac.2023.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/06/2023]
Abstract
Interstitial lung disease is a common complication of anti-neutrophil cytoplasmic antibody-associated vasculitis (AAV). It is seen most commonly in microscopic polyangiitis owing to the pathogenic effect of myeloperoxidase in the lung. Oxidative stress, neutrophil elastase release, and expression of inflammatory proteins by neutrophil extracellular traps result in fibroblast proliferation and differentiation and therefore fibrosis. Usually, interstitial pneumonia pattern fibrosis is common and associated with poor survival. Treatment for patients with AAV and interstitial lung disease lacks evidence, and those with vasculitis are treated with immunosuppression, whereas those with progressive fibrosis may well benefit from antifibrotic therapy.
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16
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Li J, Zhang J, Shi M, Yu S, Ji M, Liang Y, Meng X. Crosstalk between Inflammation and Hemorrhage/Coagulation Disorders in Primary Blast Lung Injury. Biomolecules 2023; 13:biom13020351. [PMID: 36830720 PMCID: PMC9953683 DOI: 10.3390/biom13020351] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Revised: 01/26/2023] [Accepted: 02/08/2023] [Indexed: 02/15/2023] Open
Abstract
Primary blast lung injury (PBLI), caused by exposure to high-intensity pressure waves from explosions in war, terrorist attacks, industrial production, and life explosions, is associated with pulmonary parenchymal tissue injury and severe ventilation insufficiency. PBLI patients, characterized by diffused intra-alveolar destruction, including hemorrhage and inflammation, might deteriorate into acute respiratory distress syndrome (ARDS) with high mortality. However, due to the absence of guidelines about PBLI, emergency doctors and rescue teams treating PBLI patients rely on experience. The goal of this review is to summarize the mechanisms of PBLI and their cross-linkages, exploring potential diagnostic and therapeutic targets of PBLI. We summarize the pathophysiological performance and pharmacotherapy principles of PBLI. In particular, we emphasize the crosstalk between hemorrhage and inflammation, as well as coagulation, and we propose early control of hemorrhage as the main treatment of PBLI. We also summarize several available therapy methods, including some novel internal hemostatic nanoparticles to prevent the vicious circle of inflammation and coagulation disorders. We hope that this review can provide information about the mechanisms, diagnosis, and treatment of PBLI for all interested investigators.
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Affiliation(s)
- Junfeng Li
- Institute of Disaster and Emergency Medicine, Tianjin University, Tianjin 300072, China
- Tianjin Key Laboratory of Disaster Medicine Technology, Tianjin 300072, China
| | - Jianfeng Zhang
- Wenzhou Safety (Emergency) Institute, Tianjin University, Wenzhou 325000, China
- Key Laboratory of Medical Rescue Key Technology and Equipment, Ministry of Emergency Management, Wenzhou 325000, China
| | - Mingyu Shi
- Institute of Disaster and Emergency Medicine, Tianjin University, Tianjin 300072, China
- Tianjin Key Laboratory of Disaster Medicine Technology, Tianjin 300072, China
| | - Sifan Yu
- Institute of Disaster and Emergency Medicine, Tianjin University, Tianjin 300072, China
- Tianjin Key Laboratory of Disaster Medicine Technology, Tianjin 300072, China
| | - Mengjun Ji
- Institute of Disaster and Emergency Medicine, Tianjin University, Tianjin 300072, China
- Tianjin Key Laboratory of Disaster Medicine Technology, Tianjin 300072, China
| | - Yangfan Liang
- Institute of Disaster and Emergency Medicine, Tianjin University, Tianjin 300072, China
- Tianjin Key Laboratory of Disaster Medicine Technology, Tianjin 300072, China
| | - Xiangyan Meng
- Institute of Disaster and Emergency Medicine, Tianjin University, Tianjin 300072, China
- Tianjin Key Laboratory of Disaster Medicine Technology, Tianjin 300072, China
- Wenzhou Safety (Emergency) Institute, Tianjin University, Wenzhou 325000, China
- Key Laboratory of Medical Rescue Key Technology and Equipment, Ministry of Emergency Management, Wenzhou 325000, China
- Correspondence:
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17
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Saha BK, Aiman A, Chong WH, Saha S, Song J, Bonnier A. Updates in idiopathic pulmonary hemosiderosis in 2022: A state of the art review. Pediatr Pulmonol 2023; 58:382-391. [PMID: 36324124 DOI: 10.1002/ppul.26230] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Revised: 09/14/2022] [Accepted: 11/02/2022] [Indexed: 11/06/2022]
Abstract
This manuscript reports the recent advances in idiopathic pulmonary hemosiderosis (IPH), a rare cause of diffuse alveolar hemorrhage in children and adults. This narrative review of the literature summarizes different aspects of IPH, including proposed pathogenesis, patient demographics, clinical and radiological characteristics, treatment, and prognosis. Additionally, the association between Celiac Disease (CD) and IPH is carefully evaluated. IPH is a frequently misdiagnosed disease. The delay in the diagnosis of IPH is often significant but fortunately, appears to have decreased in recent years. IPH in adults and children have distinct demographic preferences. The autoantibodies are common in IPH but with a definite difference between the adult and pediatric populations. The definitive diagnosis of IPH requires lung biopsy and careful exclusion of all competing diagnoses, even with lung biopsy showing bland pulmonary hemorrhage. The presence of nonspecific inflammatory cells or lymphoid aggregates may suggest a secondary immunologic phenomenon and needs careful evaluation and follow-up. A substantial number of patients suffer from coexisting CD, also known as Lane-Hamilton syndrome (LHS), and all patients with IPH need to be evaluated for LHS by serology. Although strict gluten free diet can manage the majority of patients with LHS, other patients generally require immunosuppressive therapy. The corticosteroids are the backbone of IPH therapy. Recently utilized experimental treatment options include mesenchymal stem cell transplant, liposteroid and bronchial artery embolization. The immunosuppression should be adjusted to achieve optimal disease control. Patients may progress to end-stage lung disease despite all measures, and lung transplantation may be the only viable option.
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Affiliation(s)
- Biplab K Saha
- Department of Pulmonary, Critical Care and Sleep Medicine, University of Florida, Gainesville, Florida, USA
| | - Alexis Aiman
- New York Institute of Technology College of Osteopathic Medicine at Arkansas State University, Arkansas, USA
| | - Woon Hean Chong
- Department of Intensive Care Medicine, Ng Teng Fong General Hospital, National University Health System, Singapore City, Singapore
| | - Santu Saha
- Department of Internal Medicine, Saha Clinic, Narail, Bangladesh
| | - Jini Song
- New York Institute of Technology College of Osteopathic Medicine at Arkansas State University, Arkansas, USA
| | - Alyssa Bonnier
- Department of Critical Care Nursing, Goldfarb School of Nursing, Barnes Jewish College, St. Louis, Missouri, USA
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18
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Muacevic A, Adler JR, Moreira M, Pardal N, Lopes Freitas R. Lane-Hamilton Syndrome in an Adult With Down Syndrome: A Case Report. Cureus 2023; 15:e33385. [PMID: 36751263 PMCID: PMC9898870 DOI: 10.7759/cureus.33385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/04/2023] [Indexed: 01/06/2023] Open
Abstract
The Lane-Hamilton syndrome (LHS) is an extremely rare association between celiac disease (CD) and idiopathic pulmonary hemosiderosis (IPH), with only a few cases reported in the literature. The authors report a case of a 32-year-old man with Down syndrome who presented to the emergency department with a history of hemoptysis and chronic diarrhea. The complementary investigation revealed iron deficiency anemia and features suggestive of diffuse alveolar hemorrhage on computed tomography (CT) scan of the chest. After excluding all competing diagnosis, the IPH diagnosis was made. The biopsy of the small intestine confirmed CD and the diagnosis of LHS was established. A gluten-free diet and steroids were given to the patient with a very good clinical response. Since there is an established association between IPH and CD, if the diagnosis of IPH is made, it's recommended to screen for CD even in patients without gastrointestinal symptoms.
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Kuwahara Y, Tashiro H, Takahashi K, Kimura S, Sueoka-Aragane N. A 45-Year-Old Woman With Unexplained Iron Deficiency Anemia and No Respiratory Symptoms. Chest 2023; 163:e7-e11. [PMID: 36628691 DOI: 10.1016/j.chest.2022.07.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Revised: 07/26/2022] [Accepted: 07/27/2022] [Indexed: 01/11/2023] Open
Abstract
CASE PRESENTATION A 45-year-old Japanese woman was diagnosed with anemia in a work place medical check-up and came to our hospital for further investigations. She had experienced general fatigue and orthostatic dizziness for 6 months without fever or respiratory symptoms, including cough, sputum, hemoptysis, or dyspnea. She had undergone annual medical check-ups previously, which had shown no abnormalities, including anemia. She had no history of weight loss, epimenorrhagia, hematuria, or melena. She had no significant positive medical history and was not on any regular medication or supplements. She had no history of alcohol abuse or smoking.
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Affiliation(s)
- Yuki Kuwahara
- Division of Hematology, Respiratory Medicine and Oncology, Department of Internal Medicine, Faculty of Medicine, Saga University Hospital, Saga, Japan
| | - Hiroki Tashiro
- Division of Hematology, Respiratory Medicine and Oncology, Department of Internal Medicine, Faculty of Medicine, Saga University Hospital, Saga, Japan.
| | - Koichiro Takahashi
- Division of Hematology, Respiratory Medicine and Oncology, Department of Internal Medicine, Faculty of Medicine, Saga University Hospital, Saga, Japan
| | - Shinya Kimura
- Division of Hematology, Respiratory Medicine and Oncology, Department of Internal Medicine, Faculty of Medicine, Saga University Hospital, Saga, Japan
| | - Naoko Sueoka-Aragane
- Division of Hematology, Respiratory Medicine and Oncology, Department of Internal Medicine, Faculty of Medicine, Saga University Hospital, Saga, Japan
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20
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Rituximab in Idiopathic Pulmonary Hemosiderosis in Children: A Novel and Less Toxic Treatment Option. Pharmaceuticals (Basel) 2022; 15:ph15121549. [PMID: 36559000 PMCID: PMC9784529 DOI: 10.3390/ph15121549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Revised: 12/05/2022] [Accepted: 12/07/2022] [Indexed: 12/15/2022] Open
Abstract
Idiopathic pulmonary hemosiderosis (IPH) is a rare, potentially life-threatening chronic disease. Steroids are the cornerstone of treatment, even though toxicity and side-effects are very common. Recently, rituximab (RTX) has been suggested as a treatment option, although evidence for its efficacy and long-term safety is lacking. We describe the disease course of two pediatric patients with IPH that were treated with RTX for over 4 years. Demographics, treatments, and clinical variables such as growth, infections, imaging follow-up by CT, and data from pulmonary function tests were retrospectively described. These are the first two cases described with a long-term follow-up of pediatric IPH patients treated with RTX. RTX was well-tolerated and prevented outbreaks of bleeding. In addition, RTX had a robust steroid-sparing effect resulting in the improvement of growth, pulmonary function, and CT abnormalities.
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21
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Saha BK, Bonnier A, Saha S, Saha BN, Shkolnik B. Adult patients with idiopathic pulmonary hemosiderosis: a comprehensive review of the literature. Clin Rheumatol 2022; 41:1627-1640. [PMID: 35179664 DOI: 10.1007/s10067-022-06104-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2022] [Revised: 02/01/2022] [Accepted: 02/15/2022] [Indexed: 12/24/2022]
Abstract
Idiopathic pulmonary hemosiderosis (IPH) is a rare disease without a known incidence or prevalence in adults. Our knowledge of this entity is limited as there is no prospective or retrospective study with a reasonable number of patients. The objective is to describe the demographics, clinical manifestations, diagnosis, treatment, and prognosis of adult patients with IPH. The Medline and Embase databases were searched from inception to 2021 with appropriate search formulas to identify relevant articles following strict inclusion and exclusion criteria. Statistical analyses were performed for the entire cohort and prespecified subgroups. A total of 84 patients were identified. The majority of patients were males 54/84 (64.3%). The median age was 27 years. The manifesting symptoms were present in the following frequencies: anemia 76/83 (91.6%), dyspnea 71/83 (85.5%), hemoptysis 70/84 (83.3%), cough 22/84 (26.2%), and chest pain 9/84 (10.7%). The classic triad was present in 61/84 (79%) patients. The mean hemoglobin during the initial presentation was 8.4 gm/dL. A total of 16/57 (19.5%) tested positive for autoantibodies. The median delay in the diagnosis of IPH was 1.02 years. Immunosuppressive therapy was prescribed in 49/79 (62%) patients, and recurrence occurred in more than half of the patients 36/66 (54.5%). A total of 63/79 (79.7%) patients were alive during the final follow-up. IPH is more common in young adults with a male predominance. A high index of suspicion is necessary to attain an early diagnosis and possibly reduce the short-term mortality of nearly 20% and long-term complications.
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Affiliation(s)
- Biplab K Saha
- Department of Pulmonary and Critical Care Medicine, Ozarks Medical Center, 1100 Kentucky Avenue, West Plains, MO, 65775, USA.
| | - Alyssa Bonnier
- Department of Critical Care Nursing, Goldfarb School of Nursing, Barnes Jewish College, St. Louis, MO, USA
| | - Santu Saha
- Department of Medicine, Saha Clinic, Narail, Bangladesh
| | | | - Boris Shkolnik
- Department of Pulmonary and Critical Care Medicine, Albany Medical Center, Albany, NY, USA
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22
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Wang Z, Wang Y, Wang Y, Liu J. Hemosiderin-laden macrophages in the bronchoalveolar lavage fluid of a 6-year-old girl. Int J Lab Hematol 2022; 44:1001-1002. [PMID: 35633150 DOI: 10.1111/ijlh.13903] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Accepted: 05/16/2022] [Indexed: 11/28/2022]
Affiliation(s)
- Zhenni Wang
- Laboratory Medicine Center, Department of Clinical Laboratory, Zhejiang Provincial People's Hospital (Affiliated People's Hospital, Hangzhou Medical College), Hangzhou, Zhejiang, China
| | - Ying Wang
- Department of Anesthesiology, Xinchang Hospital Affiliated to Wenzhou Medical University, Xinchang, China
| | - Yong Wang
- Department of Clinical Laboratory, Shangyu People's Hospital of Shaoxing, Shaoxing, China
| | - Jinlin Liu
- Laboratory Medicine Center, Department of Clinical Laboratory, Zhejiang Provincial People's Hospital (Affiliated People's Hospital, Hangzhou Medical College), Hangzhou, Zhejiang, China
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23
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Saha BK, Saha S, Bonnier A, Saha BN. Association between idiopathic pulmonary hemosiderosis and celiac disease in pediatric patients: A scoping review of the literature over the past 50 years. Pediatr Pulmonol 2022; 57:1127-1144. [PMID: 35088581 DOI: 10.1002/ppul.25847] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Revised: 01/17/2022] [Accepted: 01/24/2022] [Indexed: 11/05/2022]
Abstract
INTRODUCTION Idiopathic pulmonary hemosiderosis (IPH) is a rare cause of diffuse alveolar hemorrhage, the mechanism of which is currently unknown. Nearly one-third of pediatric patients with IPH test positive for Celiac disease (CD) serology. Several hypothetical mechanisms have been proposed to unify the coexistence of these two entities, also referred to as Lane-Hamilton syndrome (LHS). METHOD This manuscript is a scoping review of the medical literature. Medline, Embase, and PubMed Central databases were searched between 1971 and 2021 with appropriate search words to identify all cases of pediatric LHS. RESULTS A total of 20 manuscripts with 23 pediatric patients with LHS were identified. The mean age was 11 years, and 13/23 (56.5%) of the children were boys. Hemoptysis was present in 57% of patients during diagnosis. Bronchoscopy with bronchoalveolar lavage demonstrating hemosiderin laden macrophages was the primary mode of diagnostic confirmation. Only three patients underwent lung biopsy. Any significant GI symptom was reported in a minority of patients (22%). Iron deficiency anemia on presentation was described in 83% of children. The majority of patients were malnourished. Serology for CD was positive in all patients, as was the histopathologic analysis of the small bowel biopsy. No patients had any other autoantibody positivity. The introduction of gluten free diet (GFD) was associated with a positive response in 20/23 patients. CONCLUSION All pediatric patients with IPH should undergo screening for CD. Low serum ferritin in patients with IPH could be suggestive of coexisting CD. Strict GFD should be tried as the initial therapy.
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Affiliation(s)
- Biplab K Saha
- Department of Pulmonary and Critical Care Medicine, Ozarks Medical Center, West Plains, Missouri, USA
| | - Santu Saha
- Department of Internal Medicine, Bangladesh Medical College, Dhaka, Bangladesh
| | - Alyssa Bonnier
- Department of Critical Care Nursing, Goldfarb School of Nursing, Barnes Jewish College, St. Louis, Missouri, USA
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Fukushima K, Hara A, Kido T, Ono R, Zaizen Y, Yamane Y, Ishimoto H, Sakamoto N, Fukuoka J, Mukae H. Recurrence of idiopathic pulmonary hemosiderosis in adults with childhood onset: A case report and literature review. Respir Investig 2022; 60:438-442. [PMID: 35307363 DOI: 10.1016/j.resinv.2022.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Revised: 01/27/2022] [Accepted: 02/18/2022] [Indexed: 10/18/2022]
Abstract
We describe a rare case of a 20-year-old Japanese man with idiopathic pulmonary hemosiderosis (IPH) recurrence in adults with childhood onset (racIPH). IPH commonly occurs in children, and data regarding racIPH are lacking. A review of the literature showed that only five cases of racIPH have been reported (including the present case) and that racIPH shows features that are intermediate between childhood- and adult-onset IPH with respect to age and a lower frequency of smoking history. We also found that the degree of anemia was usually not severe, and a favorable response to corticosteroid therapy is expected in racIPH.
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Affiliation(s)
- Koki Fukushima
- Department of Respiratory Medicine, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki City, Nagasaki, 852-8501, Japan
| | - Atsuko Hara
- Department of Respiratory Medicine, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki City, Nagasaki, 852-8501, Japan
| | - Takashi Kido
- Department of Respiratory Medicine, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki City, Nagasaki, 852-8501, Japan.
| | - Rika Ono
- Department of Respiratory Medicine, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki City, Nagasaki, 852-8501, Japan
| | - Yoshiaki Zaizen
- Department of Pathology, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki City, Nagasaki, 852-8520, Japan
| | - Yusuke Yamane
- Department of Surgical Oncology, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki City, Nagasaki, 852-8520, Japan
| | - Hiroshi Ishimoto
- Department of Respiratory Medicine, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki City, Nagasaki, 852-8501, Japan
| | - Noriho Sakamoto
- Department of Respiratory Medicine, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki City, Nagasaki, 852-8501, Japan
| | - Junya Fukuoka
- Department of Pathology, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki City, Nagasaki, 852-8520, Japan
| | - Hiroshi Mukae
- Department of Respiratory Medicine, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki City, Nagasaki, 852-8501, Japan
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Li C, Zhang H, Mo J, Wang Y, Song D, Wu P, Xiong Y, Qiu J, Wang G, Ye L. An Infant With Interstitial Lung Disease of Rare Cause. Chest 2022; 161:e273-e278. [DOI: 10.1016/j.chest.2021.12.639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Revised: 11/30/2021] [Accepted: 12/12/2021] [Indexed: 11/30/2022] Open
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Saha BK, Bonnier A, Saha S, Saha BN, Milman NT. The Spectrum of Autoantibodies in Adult Patients With Idiopathic Pulmonary Hemosiderosis: A Brief Review of the Literature. Cureus 2022; 14:e24169. [PMID: 35586354 PMCID: PMC9108010 DOI: 10.7759/cureus.24169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/15/2022] [Indexed: 11/23/2022] Open
Abstract
While autoimmune antibodies or autoantibodies have been reported sporadically in adult patients with idiopathic pulmonary hemosiderosis (IPH), their true prevalence is unknown. The question as to whether any difference exists between antibody-positive and negative patients has not been explored. The primary objective of this paper was to assess the spectrum of autoantibody testing and its positivity rate. The other objectives included a comparative analysis of demographics, symptom onset, clinical manifestations, and differences in clinical outcomes between antibody-positive (cohort A) and negative (cohort B) patients. To that end, we conducted a retrospective review of the relevant published literature. Multiple databases were searched to retrieve studies published between 1990 and 2022. A total of 35 studies, involving 38 patients, were identified. Five of these patients had a positive autoantibody. Patients in cohort A were older and more likely to be male. The frequencies of testing for these antibodies were as follows: antineutrophil cytoplasmic antibody (ANCA): 37/38 (97.4%), antinuclear antibody (ANA): 31/38 (81.6%), and anti-glomerular basement membrane antibody (anti-GBM): 30/38 (78.9%); 5/38 (13.2%) patients tested positive for an autoantibody, and two of these patients were positive for ANA, two for antithyroid antibody, and one patient tested positive for ANCA, rheumatoid factor (RF), and granulocyte monocyte-colony stimulating factor (GM-CSF) antibody. There was no difference between the cohorts regarding their clinical presentations, recurrence risks, and survival. The occurrence of autoantibodies is uncommon in adult IPH patients. This is in contrast with the pediatric IPH patient population, where the prevalence is much higher (26.4% vs. 13.2%), and the antibodies are more diverse. Unlike pediatric patients, adult patients with autoantibodies do not necessarily have worse outcomes.
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27
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Saha BK, Chong WH, Saha S, Aiman A, Bonnier A. Proposed Pathogenesis of Diffuse Alveolar Hemorrhage in Idiopathic Pulmonary Hemosiderosis. Lung 2022; 200:205-215. [PMID: 35267072 DOI: 10.1007/s00408-022-00523-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Accepted: 02/27/2022] [Indexed: 01/01/2023]
Abstract
Idiopathic pulmonary hemosiderosis (IPH) is a rare disease that causes diffuse alveolar hemorrhage (DAH). The latest data suggests an immunologic origin of IPH, and a new name, immune mediated pulmonary hemosiderosis (ImPH), has been proposed. However, the exact immunologic mechanism has remained elusive for nearly eight decades despite extensive research, including detailed histopathologic analysis. Although several hypotheses have been proposed to describe the pathobiology of IPH, none of them explain the clinical and histopathologic findings conclusively. In this manuscript, we have presented a new hypothesis for the pathogenesis of DAH in IPH. We hypothesize that DAH in IPH is not immunocomplex mediated but due to histamine, eosinophilic cationic protein (ECP), and possibly vascular endothelial growth factor (VEGF). These bioactive proteins induce endothelial and alveolar epithelial damage, leading to the peri-capillary and intraalveolar escape of RBCs. The deformability of the RBC likely also plays a role. The supranormal secretion of histamine, ECP and VEGF occurs in genetically predisposed individuals with an aberrant immunologic response. The histamine is released from the basophils and possibly the mast cells in response to cytokines secreted by activated lymphocytes. The lymphocyte activation occurs after exposure to a known (gluten) or unknown antigen. The same lymphocyte-derived cytokines also induce eosinophilic degranulation of ECP and VEGF in the pulmonary circulation. We believe that our hypothesis unifies the observed clinical variabilities and histopathologic findings in IPH, and we hope that would promote future research in the field of IPH.
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Affiliation(s)
- Biplab K Saha
- Department of Pulmonary and Critical Care Medicine, Ozarks Medical Center, 1100 Kentucky Avenue, West Plains, Missouri, MO, 65775, USA.
| | - Woon H Chong
- Department of Pulmonary and Critical Care Medicine, Albany Medical Center, Albany, NY, USA
| | - Santu Saha
- Department of Internal Medicine, Bangladesh Medical College, Dhaka, Bangladesh
| | - Alexis Aiman
- New York Institute of Technology College of Osteopathic Medicine, Arkansas State University, Arkansas, USA
| | - Alyssa Bonnier
- Department of Critical Care Nursing, Goldfarb School of Nursing, Barnes Jewish College, St. Louis, MO, USA
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A 24-Year-Old Man With Dyspnea and a Broken Left Femur. Chest 2022; 161:e225-e231. [DOI: 10.1016/j.chest.2021.10.026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Revised: 09/28/2021] [Accepted: 10/23/2021] [Indexed: 01/18/2023] Open
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Saha BK, Bonnier A, Chenna P, Milman NT. Prevalence of autoantibodies in pediatric patients with idiopathic pulmonary hemosiderosis: a scoping review of the literature in the period 1980-2021. Clin Rheumatol 2022; 41:977-990. [PMID: 35067768 DOI: 10.1007/s10067-021-06029-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Revised: 12/04/2021] [Accepted: 12/18/2021] [Indexed: 11/03/2022]
Abstract
Idiopathic pulmonary hemosiderosis (IPH) is a rare disease of unknown etiology. Due to the frequent findings of autoimmune antibodies - autoantibodies, immunologic causation of the diffuse alveolar hemorrhage in IPH has been proposed, to assess the prevalence/frequency and type of autoantibodies in pediatric patients with IPH. In addition, the patient demographics, diagnostic modalities used to diagnose IPH, treatment, and outcomes were also evaluated. Scoping review: The PubMed, Medline, and Embase databases were searched with appropriate MeSH terms to identify relevant papers consistent with the defined inclusion criteria. Thirteen observational studies comprising a total of 352 pediatric patients were included in this review. The majority of subjects were girls 217 out of 352 (61.6%). The mean and median ages of patients ranged from 3.1-6.5 years to 2.3-7 years, respectively. In the 10 studies that specified the number of patients in their cohorts with either at least one positive autoantibody or no antibody, the overall prevalence of autoantibodies was 76 out of 288 patients (26.4%). The prevalence of specific antibodies was as follows: ANA, 20.3%; ANCA, 17%; anti-dsDNA, 9.1%; RF, 12%; anti-SMA, 23.2%; and celiac antibodies, 25.9%. Cow's milk protein allergy was present in 16.2% of the children. The significance of an association between IPH and the presence of autoantibodies has not been clarified. The autoantibodies could be suggestive of an overall immune dysregulation rather than causation. However, limited evidence based on a single study suggests that the presence of ANA may be associated with a higher risk of recurrence and worse outcomes. Further research, including prospective studies, will be crucial to explore a possible genetic linkage between vasculitides, systemic rheumatologic diseases, and IPH.
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Affiliation(s)
- Biplab K Saha
- Division of Pulmonary and Critical Care Medicine, Ozarks Medical Center, 1100 Kentucky Avenue, West Plains, MO, 65775, USA.
| | - Alyssa Bonnier
- Goldfarb School of Nursing at Barnes-Jewish College, Saint Louis, MO, USA
| | - Praveen Chenna
- Division of Pulmonary and Critical Care Medicine, Washington University School of Medicine, Saint Louis, MO, USA
| | - Nils T Milman
- Department of Clinical Biochemistry, Næstved Hospital, University College Zealand, 4700, Næstved, Denmark
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Saha BK, Datar P, Aiman A, Bonnier A, Saha S, Milman NT. Comparative Analysis of Adult Patients With Idiopathic Pulmonary Hemosiderosis and Lane-Hamilton Syndrome: A Systematic Review of the Literature in the Period 1971-2022. Cureus 2022; 14:e23482. [PMID: 35475077 PMCID: PMC9035284 DOI: 10.7759/cureus.23482] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/25/2022] [Indexed: 12/16/2022] Open
Abstract
Idiopathic pulmonary hemosiderosis (IPH) causes diffuse alveolar hemorrhage (DAH) by a yet unknown mechanism. The coexistence of IPH and celiac disease (CD), also known as Lane-Hamilton syndrome (LHS), has been reported in both pediatric and adult patients. The objective of this study was to compare demographics, clinical and radiologic findings, treatment, and outcomes between adult patients with IPH and LHS. This is a systematic review of the literature. Multiple databases were searched using appropriate formulas to identify relevant articles. A total of 60 studies reporting 65 patients were included in the review. Forty-nine of these patients had IPH and 16 had LHS. The prevalence of anti-CD antibodies among tested patients was 13/22 (59%). The symptom onset and diagnosis of IPH occurred earlier in patients with LHS. The median delay in diagnosis was the same between the two groups (52 weeks). The classic triad was more likely to be present in patients with LHS. Only 20% of patients in the LHS cohort had any significant gastrointestinal (GI) symptoms at the time of IPH diagnosis. A gluten-free diet alone was effective in the majority of patients. Fewer patients in the LHS cohort received systemic corticosteroid than the IPH cohort. The recurrence and mortality in patients with LHS appear to be less than in the IPH cohort. The prevalence of CD is 25% in adult patients with IPH. Patients with LHS may have a milder course than patients without CD. Serologic testing for CD should be performed in all patients diagnosed with IPH.
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Bertolizio G, Engelhardt T, Veyckemans F. Congenital interstitial lung diseases: What the anesthesiologist needs to know. Paediatr Anaesth 2022; 32:138-147. [PMID: 34738691 DOI: 10.1111/pan.14325] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Revised: 10/22/2021] [Accepted: 11/01/2021] [Indexed: 01/06/2023]
Abstract
Congenital interstitial lung diseases can affect both adults and children. Pediatric congenital interstitial lung diseases generally carry high risk for morbidly and mortality and include congenital alveolar capillary dysplasia with misalignment of pulmonary veins, congenital alveolar dysplasia, acinar dysplasia, congenital pulmonary lymphangiectasis, diffuse pulmonary lymphangiomatosis, neuroendocrine cell hyperplasia of infancy, pulmonary hemosiderosis, pulmonary alveolar proteinosis, and pulmonary interstitial glycogenosis. Given their usual non-specific clinical presentation, they are frequently misdiagnosed and recognized late, particularly in children who have been apparently healthy for several years (eg, diffuse pulmonary lymphangiomatosis). Some diseases have a very poor prognosis, whereas others have a benign course with appropriate treatment. The current manuscript reviews congenital interstitial lung diseases that typically affect neonates and young children and may be encountered by the pediatric anesthesiologist.
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Affiliation(s)
- Gianluca Bertolizio
- Department of Pediatric Anesthesiology, Montreal Children's Hospital, McGill University, Montreal, QC, Canada
| | - Thomas Engelhardt
- Department of Pediatric Anesthesiology, Montreal Children's Hospital, McGill University, Montreal, QC, Canada
| | - Francis Veyckemans
- Clinique d'Anesthésie pédiatrique, Hôpital Jeanne de Flandre, CHU de Lille, Lille, France
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Saha BK, Chong WH, Milman NT. Differentiation of idiopathic pulmonary hemosiderosis from rheumatologic and autoimmune diseases causing diffuse alveolar hemorrhage: establishing a diagnostic approach. Clin Rheumatol 2022; 41:325-336. [PMID: 34491458 DOI: 10.1007/s10067-021-05895-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Revised: 08/20/2021] [Accepted: 08/23/2021] [Indexed: 12/11/2022]
Abstract
This narrative review provides an overview of diffuse alveolar hemorrhage (DAH) associated with rheumatologic and autoimmune diseases and their differentiation from idiopathic pulmonary hemosiderosis (IPH). Relevant immunologic diseases associated with DAH are discussed, and a diagnostic flowchart is proposed to establish a "definitive" diagnosis of IPH within the spectrum of DAH. IPH is a rare cause of recurrent DAH both in children and adults. In adults, a definitive diagnosis of IPH requires a lung biopsy and histopathologic examination demonstrating intraalveolar hemorrhage, hemosiderin-laden macrophages, and a variable degree of fibrosis in the absence of both capillaritis and cellular inflammation. The presence of small vessel vasculitis points towards immunologic, well-differentiated, or sometimes undifferentiated rheumatologic diseases. However, it is essential to recognize that many rheumatologic diseases may in the initial phase present with DAH without any evidence of capillaritis, thus mimicking IPH. Although not definitely established, it is likely that immunologic processes are involved in IPH, and we, therefore, suggest the consideration of a more suitable term for the disease, e.g., "Immune-mediated Pulmonary Hemosiderosis" to acknowledge the aberrancy in the immune parameters and a positive response to immunosuppressive therapy.
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Affiliation(s)
- Biplab K Saha
- Division of Pulmonary and Critical Care Medicine, Ozarks Medical Center, West Plains, MO, USA.
| | - Woon H Chong
- Division of Pulmonary and Critical Care Medicine, Albany Medical Center, Albany, NY, USA
| | - Nils T Milman
- Department of Clinical Biochemistry, Næstved Hospital, University College Zealand, 4700, Næstved, Denmark
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Saha BK, Chong WH. Lung transplant to manage end-stage lung disease due to idiopathic pulmonary hemosiderosis: A review of the literature. Respir Investig 2022; 60:82-89. [PMID: 34312096 DOI: 10.1016/j.resinv.2021.06.009] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Revised: 06/05/2021] [Accepted: 06/19/2021] [Indexed: 06/13/2023]
Abstract
Idiopathic pulmonary hemosiderosis (IPH) is a rare immunological disease with a genetic predisposition. It is characterized by recurrent episodes of diffuse alveolar hemorrhage (DAH). Timely use of immunosuppressive medications has significantly improved overall outcomes, including mortality. Still, uncontrolled and frequent episodes of DAH can eventually cause pulmonary fibrosis, leading to end-stage lung disease (ESLD). The objective of the present project was to scrutinize the literature and summarize the demographic, clinical, radiological, and histopathological features, as well as the overall outcomes, in this patient population following lung transplant. The Medline database was searched using the PubMed platform. Articles published in English between 1960 and 2020 were included in the search. Different search terms were used to identify all patients who underwent lung transplantation to manage ESLD due to IPH. Only four cases of lung transplantation have been reported in the literature in patients with IPH. All but one of these underwent deceased donor lung transplant; recurrence was reported in two of these patients and suspected in the third. One patient received living donor lung transplant and had no recurrence during a five-year follow-up. Patients with IPH should not be excluded from lung transplantation because the disease may not recur in all patients, and even when it does recur it can be promptly treated by increasing immunosuppression.
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Affiliation(s)
- Biplab K Saha
- Division of Pulmonary and Critical Care Medicine, Ozarks Medical Center, 1100 N Kentucky Avenue, West Plains, MO, 65775, USA.
| | - Woon H Chong
- Division of Pulmonary and Critical Care Medicine, Albany Medical College, 43 New Scotland Avenue, Albany, NY, 12208, USA
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Hirade T, Moriyama A, Wada K, Nakashima S, Taketani T. Idiopathic pulmonary hemosiderosis: A mimic of severe COVID-19 pneumonia. Pediatr Int 2022; 64:e14991. [PMID: 35225402 PMCID: PMC9115395 DOI: 10.1111/ped.14991] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Revised: 09/02/2021] [Accepted: 09/13/2021] [Indexed: 01/05/2023]
Affiliation(s)
- Tomohiro Hirade
- Department of PediatricsShimane Prefectural Central HospitalShimaneJapan
| | - Aisa Moriyama
- Department of PediatricsFaculty of MedicineShimane UniversityShimaneJapan
| | - Keisuke Wada
- Department of PediatricsFaculty of MedicineShimane UniversityShimaneJapan
| | - Shigeki Nakashima
- Department of PediatricsFaculty of MedicineShimane UniversityShimaneJapan
| | - Takeshi Taketani
- Department of PediatricsFaculty of MedicineShimane UniversityShimaneJapan
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Saha BK, Milman NT. Liposteroid Therapy for Idiopathic Pulmonary Hemosiderosis: A Scoping Review of the Literature. Prague Med Rep 2022; 123:65-81. [PMID: 35507939 DOI: 10.14712/23362936.2022.7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
Idiopathic pulmonary hemosiderosis (IPH) is a rare cause of diffuse alveolar hemorrhage (DAH). Glucocorticosteroids (CS) represent the first line therapy for IPH. Although most patients respond to CS, steroid refractoriness is seen in an appreciable minority of patients. This paper reviews and evaluates the efficacy and safety profile of liposomal dexamethasone 21-palmitate (liposteroid) for the treatment of IPH. Medline, Embase and Web of Science biomedical databases were searched between 1980 and 2020 to identify papers describing patients with IPH, who were treated with liposteroid. A total of five articles were identified. Four in the form of case reports and one as a case series. A total of 12 pediatric patients (5 boys, 7 girls) were identified, with a median age of 2.3 years (range 0.5-8.6). Liposteroid therapy in intravenous doses ranging 0.06-0.1 mg/kg body weight appeared to be effective for both remission induction therapy, and maintenance therapy. There was no mortality among patients treated with liposteroid, either in the acute phase or during follow-up. The majority of patients for whom long-term follow-up data were available, were cured or in disease remission. No acute adverse events were reported, and long-term side effects were minimal and tolerable. Liposteroid represents a potential alternative or supplement to conventional CS therapy, as it appears to be more efficacious and associated with fewer side effects. Larger prospective, controlled trials are necessary to be able to define more precisely the therapeutic role of liposteroid in IPH.
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Affiliation(s)
- Biplab K Saha
- Division of Pulmonary and Critical Care Medicine, Ozarks Medical Center, West Plains, USA.
| | - Nils T Milman
- Department of Clinical Biochemistry, Næstved Hospital, University College Zealand, Næstved, Denmark
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Saha BK, Milman NT. Short Review of Liposteroid: A Novel Targeted Glucocorticoid Preparation for Treatment of Autoimmune and Inflammatory Diseases. Prague Med Rep 2021; 122:257-268. [PMID: 34924103 DOI: 10.14712/23362936.2021.23] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
This paper briefly reviews the safety and efficacy of liposteroid in different inflammatory and non-inflammatory diseases. Corticosteroids (CS) are the first-line therapy in many inflammatory and autoimmune disorders. Although highly efficacious, long-term use of CS is limited due to the occurrence of significant side effects. Liposteroid, which is a liposomal formulation of dexamethasone palmitate, possess more potent anti-inflammatory and immunosuppressive properties compared to dexamethasone sodium phosphate. These two formulations have markedly different lipid solubility, resulting in different pharmacokinetic and pharmacodynamic properties. Liposteroid has been used with success in patients with rheumatoid arthritis, macrophage activation syndrome, and idiopathic pulmonary hemosiderosis. In addition, liposteroid has been used in some non-inflammatory diseases. Moreover, we conceive that liposteroid may have a beneficial effect in patients, who are critically ill due to COVID-19, and suffer from the macrophage activation syndrome.
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Affiliation(s)
- Biplab K Saha
- Division of Pulmonary and Critical Care Medicine, Ozarks Medical Center, West Plains, USA.
| | - Nils T Milman
- Department of Clinical Biochemistry, Næstved Hospital, University College Zealand, Næstved, Denmark
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Iwasaki K, Matsuzawa Y, Wakabayashi H, Kumano K. Diffuse alveolar haemorrhage with suspected idiopathic pulmonary hemosiderosis and decrease in lung diffusing capacity and chronic respiratory failure. BMJ Case Rep 2021; 14:e242901. [PMID: 34215641 PMCID: PMC8256727 DOI: 10.1136/bcr-2021-242901] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/10/2021] [Indexed: 11/30/2022] Open
Abstract
Idiopathic pulmonary hemosiderosis (IPH) is a rare disease of unknown aetiology that causes recurrent episodes of diffuse alveolar haemorrhage (DAH). A male patient in his 50s had repeatedly experienced hemoptysis for the past 6 years, along with a decrease in the pulmonary diffusing capacity and chronic respiratory failure. After a 6-year follow-up, the patient experienced sudden exacerbation of hemoptysis and respiratory failure, and he was hospitalised. A CT of the chest revealed diffuse pulmonary infiltrates, whereas the bronchoalveolar lavage revealed hemosiderin-laden macrophages. Thus, the patient was diagnosed with DAH. As all diseases that cause DAH other than IPH were negative, the patient was suspected of IPH. He was treated with a combination of glucocorticoids and azathioprine, and his hemoptysis and chronic respiratory failure improved; however, the decrease in the pulmonary diffusing capacity did not improve. Treating adult-onset IPH with glucocorticoids and azathioprine might not improve pulmonary diffusing capacity.
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Affiliation(s)
- Kotaro Iwasaki
- Department of Internal Medicine, Toho University Medical Center Sakura Hospital, Sakura, Japan
| | - Yasuo Matsuzawa
- Department of Internal Medicine, Toho University Medical Center Sakura Hospital, Sakura, Japan
| | - Hiroki Wakabayashi
- Department of Internal Medicine, Toho University Medical Center Sakura Hospital, Sakura, Japan
| | - Kotaro Kumano
- Department of Internal Medicine, Toho University Medical Center Sakura Hospital, Sakura, Japan
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Arasi S, Mastrorilli C, Pecoraro L, Giovannini M, Mori F, Barni S, Caminiti L, Castagnoli R, Liotti L, Saretta F, Marseglia GL, Novembre E. Heiner Syndrome and Milk Hypersensitivity: An Updated Overview on the Current Evidence. Nutrients 2021; 13:nu13051710. [PMID: 34070007 PMCID: PMC8157832 DOI: 10.3390/nu13051710] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Revised: 05/14/2021] [Accepted: 05/17/2021] [Indexed: 01/21/2023] Open
Abstract
Infants affected by Heiner syndrome (HS) display chronic upper or lower respiratory tract infections, including otitis media or pneumonia. Clinically, gastrointestinal signs and symptoms, anemia, recurrent fever and failure to thrive can be also present. Chest X-rays can show patchy infiltrates miming pneumonia. Clinical manifestations usually disappear after a milk-free diet. The pathogenetic mechanism underlying HS remains unexplained, but the formation of immune complexes and the cell-mediated reaction have been proposed. Patients usually outgrow this hypersensitivity within a few years. The aim of this review is to provide an updated overview on the current evidence on HS in children, with a critical approach on the still undefined points of this interesting disease. Finally, we propose the first structured diagnostic approach for HS.
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Affiliation(s)
- Stefania Arasi
- Translational Research in Pediatric Specialities Area, Division of Allergy, Bambino Gesù Children’s Hospital, IRCCS, Piazza Sant’Onofrio, 4, 00165 Rome, Italy
- Correspondence: ; Tel.: +39-06-68593570
| | - Carla Mastrorilli
- Pediatric Unit and Emergency, University Hospital Consortium Corporation Polyclinic of Bari, Pediatric Hospital Giovanni XXIII, 70126 Bari, Italy;
| | - Luca Pecoraro
- Department of Medicine, University of Verona, 37129 Verona, Italy;
- Pediatric Unit, ASST Mantua, 46100 Mantua, Italy
| | - Mattia Giovannini
- Allergy Unit, Department of Pediatrics, Meyer Children’s University Hospital, 50139 Florence, Italy; (M.G.); (F.M.); (S.B.)
| | - Francesca Mori
- Allergy Unit, Department of Pediatrics, Meyer Children’s University Hospital, 50139 Florence, Italy; (M.G.); (F.M.); (S.B.)
| | - Simona Barni
- Allergy Unit, Department of Pediatrics, Meyer Children’s University Hospital, 50139 Florence, Italy; (M.G.); (F.M.); (S.B.)
| | - Lucia Caminiti
- Department of Human Pathology in Adult and Development Age “Gaetano Barresi”, Allergy Unit, Department of Pediatrics, AOU Policlinico Gaetano Martino, 98158 Messina, Italy;
| | - Riccardo Castagnoli
- Department of Pediatrics, Pediatric Clinic, Fondazione IRCCS Policlinico San Matteo, University of Pavia, 27100 Pavia, Italy; (R.C.); (G.L.M.)
| | - Lucia Liotti
- Department of Pediatrics, AOU Ospedali Riuniti Ancona, Presidio Ospedaliero di Alta Specializzazione “G. Salesi”, 60126 Ancona, Italy;
| | - Francesca Saretta
- Pediatric Department, Latisana-Palmanova Hospital, Azienda Sanitaria Universitaria Friuli Centrale, 33100 Udine, Italy;
| | - Gian Luigi Marseglia
- Department of Pediatrics, Pediatric Clinic, Fondazione IRCCS Policlinico San Matteo, University of Pavia, 27100 Pavia, Italy; (R.C.); (G.L.M.)
| | - Elio Novembre
- Department of Health Science, University of Florence, 70126 Florence, Italy;
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Saha S, Chong WH, Saha BK. Unilateral Diffuse Alveolar Hemorrhage Due to Selective Directionality of Mitral Regurgitant Jet in a Patient With Severe Aortic Stenosis. Cureus 2021; 13:e14714. [PMID: 34055553 PMCID: PMC8157819 DOI: 10.7759/cureus.14714] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
Diffuse alveolar hemorrhage (DAH) in cardiac diseases results from pulmonary capillary stress failure due to pulmonary venous hypertension. The most common cardiac causes of DAH are heart failure and mitral valvular disease. Patients typically manifest with hemoptysis, radiologic chest abnormalities, and anemia. The chest infiltrates are generally bilateral, similar to pulmonary edema. Rarely, the chest infiltrates can be unilateral, mimicking an infectious etiology. We present the case of an 88-year-old female with critical aortic stenosis, who presented with shortness of breath, unilateral right lung infiltrates, and mild leukocytosis. The patient was misdiagnosed with pneumonia as pulmonary edema or DAH was expected to be a bilateral finding on chest imaging. The patient deteriorated and DAH was eventually diagnosed by bronchoscopy.
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Affiliation(s)
- Santu Saha
- Internal Medicine, Bangladesh Medical College, Dhaka, BGD
| | - Woon H Chong
- Pulmonary and Critical Care Medicine, Albany Medical Center, Albany, USA
| | - Biplab K Saha
- Pulmonary and Critical Care Medicine, Ozarks Medical Center, West Plains, USA
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