Methylprednisolone pulse therapy rescued life-threatening pulmonary hemorrhage due to idiopathic pulmonary hemosiderosis

• Published in: The American journal of emergency medicine 2017-11, Vol.35 (11), p.1786.e3-1786.e7
• Main Authors: Li, Ya-Ting, Guo, Yu-Xiong, Cai, Liang-Ming, Pan, Li, Duan, Meng-Qi, Yang, Li-Fen, Sun, Yue-Yu, Tan, Wei-Ping, Chen, Zhuang-Gui
• Format: Article
• Language: English
• Subjects: Alveoli; Anemia; Blood pressure; Cardiac arrhythmia; Case reports; Child; Child, Preschool; Children; Corticoids; Corticosteroids; Down Syndrome - complications; Down's syndrome; Dyspnea; Emergency medical care; Female; Glucocorticoids - administration & dosage; Hemoglobin; Hemorrhage; Hemorrhage - diagnostic imaging; Hemorrhage - drug therapy; Hemorrhage - etiology; Hemosiderosis; Hemosiderosis - complications; Hemosiderosis - diagnostic imaging; Hemosiderosis, Pulmonary; Humans; Hypoxemia; Idiopathic pulmonary hemosiderosis; Lung Diseases - complications; Lung Diseases - diagnostic imaging; Lung Diseases - drug therapy; Lung Diseases - etiology; Male; Methylprednisolone; Methylprednisolone - administration & dosage; Methylprednisolone pulse therapy; Pediatrics; Pulmonary hemorrhage; Quality of life; Radiography, Thoracic; Respiratory failure; Respiratory Insufficiency - drug therapy; Respiratory Insufficiency - etiology; Tomography, X-Ray Computed; Ventilators
• ISSN: 0735-6757; 1532-8171
• DOI: 10.1016/j.ajem.2017.07.094

Idiopathic pulmonary hemosiderosis (IPH) is an extremely rare cause of massive pulmonary hemorrhage in children. During the acute phase, death due to massive alveolar hemorrhage and subsequent severe respiratory failure. We report two cases of IPH children who developed hypoxemic respiratory failure and massive pulmonary hemorrhage. One case of a 10-year-old boy was treated with methylprednisolone pulse therapy (10mg/kg/d) for the first three days and followed by systemic steroid therapy, he successfully decannulated 10days later and discharged with a favorable quality of life. Another case of a 4year-old female child with Down's syndrome diagnosed as IPH for over one year and treated with oral corticosteroids for maintenance therapy. She sudden suffered severe hypoxemia with rapid falls in the hemoglobin level. We applied methylprednisolone pulse therapy (10mg/kg/d) for three days and other supportive therapies, the girl survived through complicated with oxygen dependence. We suggest that methylprednisolone pulse therapy provides a chance of recovery and survival for patients with IPH at the acute phase, even if accompanied by severe pulmonary hemorrhage.