Pulmonary hemosiderosis with normocomplementemic urticarial vasculitis in a child
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Date
2007
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Abstract
Pulmonary hemosiderosis is rarely associated with urticarial vaculitis especially if normocomplementemic. An eigth year old girl presented with relapsing and remitting chronic and persistent urticarial lesions, conjunctival injection, recurrent cough and hemoptysis. Respiratory findings started at seven years of age. Physical examination revealed diffuse skin lesions mainly settled on the extremites, nonpurulent conjunctival injection, rare ronchi and fine crackles in bilateral lower zones of the lungs. Biopsy of the urticaria like skin lesions demonstrated leukocytoclastic vasculitis. Rheumatological markers were negative. Levels of complement fractions 3 and 4 were normal. Chest x-ray demonstrated diffuse alveolar infiltrative images. High Resolution Computed Tomography of the chest revealed diffuse ground-glass appearance, increased interstitial density. Diagnostic flexible fiberoptic bronchoscopy was performed and bronchoalveolar lavage fluid revealed hemosiderin laden alveolar macrophages. She was started on systemic corticosteroid treatment. During follow up, pulmonary symptoms disappeared, however skin lesions and conjunctival symptoms persisted and exacerbated four times in two years. CT of lungs after two years of treatment revealed rare patchy areas of ground glass appearance in bilateral lower lobes and right upper lobe as well as a few of milimetric pleural nodules. This patient is still followed up under low dose steroids and pulmonary findings regressed but low grade inflammation due to vasculitis is thought to continue as supported by the persistence of tomographic findings in the lungs despite the absence of any symptoms. This case demonstrates association of urticarial vasculitis and pulmonary hemosiderosis in the setting of normocomplementemia.
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complement component C3 , complement component C4 , corticosteroid , hemosiderin , iron , prednisolone , steroid , abnormal respiratory sound , anemia , article , asthma , case report , childhood disease , complement blood level , conjunctivitis , coughing , disease association , disease exacerbation , drug dose reduction , female , fiberoptic bronchoscopy , follow up , hemoptysis , high resolution computer tomography , human , human tissue , image analysis , immunopathogenesis , laboratory test , leukocytoclastic vasculitis , low drug dose , lung alveolus macrophage , lung hemosiderosis , lung infiltrate , lung lavage , lung nodule , onset age , physical examination , recurrent disease , school child , skin biopsy , skin defect , thorax radiography , urticaria