Abstract
BackgroundIdiopathic pulmonary hemosiderosis (IPH) encompasses a rare and agnogenic group of diffuse alveolar capillary hemorrhagic diseases. Corticosteroid treatment is the globally preferred therapeutic strategy for IPH. However, its long-term administration can cause immunodeficiency. Nocardia infection often occurs in immunocompromised patients and primarily involves the pleura and lungs. Herein, we describe a case of pediatric pulmonary Nocardia infection complicated by IPH.Case presentationA 7-year-old girl presented with chief complaints of pale complexion persisting for 1 year and a cough for 20 days. Abundant hemosiderin-laden macrophages were detected in the gastric juice during the last hospitalization. Uninterrupted small doses of corticosteroids (1–2 mg/kg/day) were administered to the patient to treat the IPH. After nearly two months of corticosteroids therapy, the children began to cough. Next-generation sequencing of the bronchoalveolar lavage fluid (BALF) sample revealed the presence of Nocardia abscessus (N. abscessus) DNA and confirmed IPH again. Linezolid was administered to treat the N. abscessus infection. She recovered well and was discharged after 18 days of hospitalization. After 1 month of follow-up, her pulmonary lesions exhibited gradual resorption, the iron deficiency anemia had resolved, and the IPH appeared to be well-controlled.ConclusionsThis pediatric case of N. abscessus infection complicated by IPH, including the nonspecific clinical manifestations, time-consuming diagnosis, and timely adjusted treatment, provided considerable clinical experience and enlightenment.
Aggressive corticosteroid treatment in childhood idiopathic pulmonary hemosiderosis with better outcome