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Diffuse alveolar hemorrhage in infants: Report of five cases
#MMPMID32802736
Gkogkou E
; Broux I
; Kempeneers C
; Boboli H
; Viellevoye R
; Janssen A
; Seghaye MC
; Mastouri M
Respir Med Case Rep
2020[]; 31
(?): 101121
PMID32802736
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Diffuse alveolar hemorrhage (DAH) is a rare life-threatening condition in
children. In this entity, the bleeding originates from the pulmonary
microvasculature as a result of microvascular damage leading to blood leakage
into the alveolar spaces. DAH can occur as an isolated medical entity or may be
associated with other organ system injury or dysfunction. The classic triad of
symptoms includes hemoptysis, anemia and diffuse pulmonary infiltrates.
Hemoptysis is the usual presenting symptom but is not constant. A variety of
diseases is associated with the development of DAH. Current classification
organize the etiologies of diffuse alveolar hemorrhage based on the presence of
severe immune disorders (such as systemic vasculitis and collagenosis) or
non-immunodeficiency disorders (with an identified cardiac or non-cardiac origin,
or idiopathic). The five cases of DAH presented in this study were all diagnosed
in full-term infants, four males and one female, with normal neonatal adaptation
and without family history of notable diseases. In all cases the diagnosis was
made between the age of three and eighteen weeks-old. Moreover, all five
patients, at the time of diagnosis, presented with hemoptysis, mild or severe
dyspnea, anemia and abnormal chest X-rays. Consequently, the diagnosis of DAH was
strongly suspected and, eventually, confirmed by bronchoscopy. Additional
laboratory tests, as well as selected serologic and radiographic studies were
performed in order to identify a specific etiology. The final diagnoses reflect a
variety of causes: infections, idiopathic pulmonary hemosiderosis, accidental
suffocation and Heiner syndrome. Treatment included oral corticosteroids except
from one patient that received antimicrobial therapy.
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