Hémosidérose pulmonaire idiopathique et maladie cœliaque chez l'enfant

Idiopathic pulmonary haemosiderosis (IPH) is a rare disease in children, and its association with celiac disease is even rarer. Its immunological origin is now well accepted. We report the case of a fifteen-year-old child admitted for evaluation of recurrent hemoptysis that had been evolving over the previous two years. Physical examination of the patient revealed normal weight and height, but there was cutaneous and mucosal pallor due to anemia (haemoglobin 4 g/dl). The chest x-rays showed alveolo-interstitiel infiltrates in both pulmonary bases. Broncho-alveolar lavage resulted in a GOLDE score of 200. The diagnosis of IPH was made. Positive tissue antitransglutaminase and antiendomysin antibodies suggested an association with celiac disease, although there were no digestive symptoms. Finally, this suspected diagnosis was confirmed by jejunal biopsy. A gluten-free diet was initiated after confirmation of the diagnosis. Evolution of the symptoms under corticosteroid therapy was initially favourable, with an increase of hemoglobin to 10 g/dl, but a relapse of hemoptysis occurred two months after the corticosteroid treatment was stopped, but at the twelve-month follow-up there had been no further hemoptysis, even though the corticosteroid had been stopped.