Abstract
We describe two Japanese children with idiopathic pulmonary haemosiderosis (IPH), whose refractory haemorrhages were treated with an intravenous lipid emulsion containing dexamethasone (liposteroid). A 22-month-old boy and a 14-month-old girl have been observed with similar symptoms; periodic bouts of anaemia, reticulocytosis, diffuse infiltrates on chest X-ray and the finding of siderophages in sputum or gastric lavage fluid. The MRI of the lung was useful for the diagnosis. Methylprednisolone pulse therapy was successful in treating acute massive bleeding. Subsequent oral prednisolone could not prevent chronic recurrent haemorrhages. However, the intermittent administration of liposteroid (0.05 mg/kg/dose IV) led to a cessation of bleeding; the haemoglobin concentration rose to normal levels. This observation emphasizes the usefulness of liposteroid in the management of refractory IPH.
Article PDF
Similar content being viewed by others
Avoid common mistakes on your manuscript.
Abbreviations
- IDA :
-
iron deficiency anaemia
- IPH :
-
idiopathic pulmonary haemosiderosis
- mPSL :
-
methylprednisolone
- UIBC :
-
unsaturated iron binding capacity
References
Aledort LM, Lord GP (1967) Idiopathic pulmonary hemosiderosis. sever anemia without hemoptysis- one year follow-up of pulmonary function. Arch Intern Med 120:220–223
Bain SC, Bryan RL, Hawkins JB (1989) Idiopathic pulmonary haemosiderosis and autoimmune thyrotoxicosis. Respiratory Med 83:447–450
Bonanomi MH, Velvart M, Stimpel M, Roos KM, Fehr K, Weder HG (1987) Studies of pharmacokinetics and therapeutic effects of glucocorticoids entrapped in liposomes after intraarticular application in healthy rabbits with antigen-induced arthritis. Rheumatology 7:203–212
Colombo JL, Stolz SM (1992) Treatment of life-threatening primary pulmonary hemosiderosis with cyclophosphamide. Chest 102:959–960
Guttenberg TJ, Moe PJ, Noren CE (1979) Diagnosis and therapeutic studies in idiopathic pulmonary hemosiderosis. Acta Paediatr Scand 68:913–914
Hoshi K, Mizushima Y, Shiokawa Y, Kageyama T, Honma M, Kashiwazaki S, Shichikawa K, Tsunematsu T, Kaneko K (1985) Double-blind study with liposteroid in rheumatoid arthritis. Drug Exptl Clin Res XI (9):621–626
Katz SM, Foster E, Miller AS, Krevolin L, Schwaqrtz AB (1989) Goodpasture's syndrome mimicking idiopathic pulmonary hemosiderosis. Ann Clin Lab Sci 19:280–286
Kjellman B, Elinder G, Garwicz S, Svan H (1984) Idiopathic pulmonary hemosiderosis in Swedish children. Acta Paediatr Scand 73:584–588
Levy J, Wilmott RW (1986) Pulmonary hemosiderosis. Pediatr Pulmonol 2:384–391
Lynch DA, Brasch RC, Hardy KA, Webb WR (1990) Pediatric pulmonary disease: assessment with high-resolution ultrafast CT. Radiology 176:243–248
Matsaniotis N, Karpouzas J, Apostolopoulou E, Messaritakis (1968) Idiopathic pulmonary hemosiderosis in children. Arch Dis Child 43:307–309
Mayumi S, Junji T, Masaru K, Toshio T, Kenzo F (1987) A case of idiopathic pulmonary hemosiderosis with depressed natural killer activity. Jpn J Pediatr (Shounika Rinshou) 40: 2287–2291
Mizushima Y, Hamano T, Yokoyama K (1982) Tissue distribution and antiinflammatory activity of corticosteroids incorporated in lipid emulsion. Ann Rheumatic Dis 41:263–267
Muller NL, Miller RR (1991) Diffuse pulmonary hemorrhage. Radiol Clin North Am 29:965–971
O'Donohue WJ Jr (1974) Idiopathic pulmonary hemosiderosis with manifestations of multiple connective tissue and immune disorders, treatment with cyclophosphamide. Am Rev Respir Dis 109:473–479
Perez-Arellano JL, Garcia J-E L, Macias MCG, Gomez FG, Lopez AJ, Castro S de (1992) Hemosiderin-laden macrophages in bronchoalveolar lavage fluid. Acta Cytol 36:26–30
Rafferty JR, Cook MK (1984) Idiopathic pulmonary haemosiderosis with autoimmune haemolytic anemia. Br J Dis Chest 78:282–285
Rubin GD, Edwards DKIII, Reicher MA, Doemeny JM, Carson SH (1989) Diagnosis of pulmonary hemosiderosis by MR imaging. AJR 152:573–574
Travis WD, Colby TV, Lombard C, Carpenter HA (1990) A clinicopathologic study of 34 cases of diffuse pulmonary hermorrhage with lung biopsy confirmation. Am J Sur Pathol 14:1112–1125
Williams S, Craver RD (1989) Cow's milk-induced pulmonary hemosiderosis. J Louisiana State Med Soc 141:19–22
Yokoyama K, Okamoto H, Watanabe M, Suyama T, Mizushima Y (1985) Development of a corticosteroid incorporated in lipid microspheres (liposteroid). Drug Exptl Clin Res XI(9):611–620
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Ohga, S., Nomura, A., Suga, N. et al. Liposteroid against refractory pulmonary haemorrhage in idiopathic pulmonary haemosiderosis. Eur J Pediatr 153, 687–690 (1994). https://doi.org/10.1007/BF02190693
Received:
Accepted:
Issue Date:
DOI: https://doi.org/10.1007/BF02190693