Children with Heiner Syndrome: A Single-Center Experience

Heiner syndrome is a rare cause of pulmonary hemosiderosis in children that is triggered by cow’s milk allergy. Herein, we describe our experience with three recent cases of Heiner syndrome with diverse clinical courses. We recommend that clinicians should consider the possibility of Heiner syndrome in children who exhibit characteristics of idiopathic pulmonary hemosiderosis.

Place of bronchoscopy in the diagnostics and follow-up of patients with idiopathic pulmonary hemosiderosis

The idiopathic pulmonary hemosiderosis is a rare, life-threatening condition observed mainly in children and characterized by recurrent episodes of diffuse alveolar hemorrhages. The disease is characterized by the triad of hemoptysis, alveolar infiltrates in chest radiography, and iron-deficiency anemia. The recurrent episodes of alveolar hemorrhage can lead to chronic iron-deficiency anemia and irreversible pulmonary fibrosis; therefore, early diagnosis and treatment are crucial to the outcome of the disease.The idiopathic pulmonary hemosiderosis is a rare, life-threatening condition observed mainly in children and characterized by recurrent episodes of diffuse alveolar hemorrhages. The disease is characterized by the triad of hemoptysis, alveolar infiltrates in chest radiography, and iron-deficiency anemia. The recurrent episodes of alveolar hemorrhage can lead to chronic iron-deficiency anemia and irreversible pulmonary fibrosis; therefore, early diagnosis and treatment are crucial to the outcome of the disease.

Idiopathic Pulmonary Hemosiderosis: An Unexplored Cause of Treatment Refractory Pediatric Iron Deficiency Anemia

Idiopathic pulmonary hemosiderosis (IPH) is an unusual cause of pediatric iron deficiency anemia (IDA) characterized by alveolar hemorrhage leading to hemosiderin deposition and fibrosis in the lungs. Though the typical triad of presentation is hemoptysis, IDA, and lung opacities on thoracic radiographs, often the sole manifestation of IPH may be severe IDA in children.

Pulmonary Nocardia infection in a child with idiopathic pulmonary hemosiderosis

Background Idiopathic 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, it 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 after the corticosteroid treatment of IPH. Case presentation A 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, which supported the diagnosis of IPH. Uninterrupted doses of corticosteroids were administered during the last hospitalization. After nearly 2 months of corticosteroids therapy, the patient began to cough and produce a purulent sputum. Next-generation sequencing of the bronchoalveolar lavage fluid revealed Nocardia abscessus (N. abscessus) DNA. Linezolid was administered with good response, and the patient was discharged after 18 days of hospitalization. Her symptoms and pulmonary lesions had recovered, and the IPH appeared to be well-controlled with low dose of corticosteroids in follow-up. Conclusions Nocardia infection should be considered in the differential diagnoses for IPH patients receiving corticosteroid therapy, especially in patients with poor response to conventional empirical antibiotic therapy. Next-generation sequencing of bronchoalveolar lavage fluid may be used to quickly identify the Nocardia. Sulfonamides or linezolid are effective for pediatric pulmonary Nocardia infection.

Pulmonary Nocardia infection in child with idiopathic pulmonary hemosiderosis: case report and literature review

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.