Atypical presentation of pulmonary hemosiderosis accompanied by tuberculosis pneumonia in childhood: Cause or association?

Abstract

Pulmonary hemosiderosis is a rare and often fatal disease characterized by repeated episodes of intra-alveolar bleeding that leads to abnormal accumulation of iron as hemosiderin in alveolar macrophages and subsequent development of pulmonary fibrosis and severe anemia. Commonly it can occur as a primary disease of the lungs, especially in children, or as a secondary
complication of cardiovascular or systemic diseases. Typically, a triad of hemoptysis (not always present in children), iron deficiency anemia, and diffuse pulmonary infiltrates characterizes pulmonary hemosiderosis. It is the absence of diagnostic features combined with the clinical picture that constitute the diagnostic criteria for these disorders. Because of difficulties in pinpointing a specific
cause of pulmonary hemosiderosis, it remains a very difficult disease to identify, continuing to be a diagnosis of exclusion. We report a case of atypical clinical presentation of pulmonary hemosiderosis accompanied by tuberculosis pneumonia diagnosed in a twelve-year-old child based on hemosiderin-laden macrophages (HLM) and a positive polymerase chain reaction (PCR) for Mycobacterium tuberculosis in bronchoalveolar lavage, simultaneously.