1st International Military Congress of Tropical Medicine and Sub-Saharan Diseases (Gabès, 2016)

Tuberculosis occurring in adult idiopathic pulmonary hemosiderosis

Pan African Medical Journal - Conference Proceedings. 2017:4(153).05 Dec 2017.
doi: 10.11604/pamj-cp.2017.4.153.361

Archived on: 05 Dec 2017

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Keywords: Tuberculosis, idiopathic pulmonary hemosiderosis, Tunisia

Abstract

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Tuberculosis occurring in adult idiopathic pulmonary hemosiderosis

Nesrine Belgacem^1,&, Najla Lassoued¹, Hassène Baïli¹, Safa Trabelsi¹, Maher Béji¹, Salem Bouomrani¹

¹Department of Internal Medicine, Gabès Military Hospital, Gabès, Tunisia

^&Corresponding author
Nesrine Belgacem, Department of Internal Medicine, Gabès Military Hospital, Gabès, Tunisia

Abstract

Introduction: idiopathic pulmonary hemosiderosis (IPH) is an exceptional chronic respiratory disorder of unknown etiology. Its prevalence is estimated at 0.24 to 1.23 cases per million and nearly 80% of the cases manifest before the age of 10. Adult forms are very rare. We describe here the case of pulmonary tuberculosis occurring in adult patient with IPH.

Methods: a 20-year-old woman was explored for recurrent hemoptysis, stage II dyspnea and chronic cough. Laboratory tests showed a microcytic and hypochromic hyposideremic anemia without other anomalies. X-rays and chest CT scans showed bilateral and diffuse alveolar-interstitial syndrome. Broncho alveolar lavage was suggesting an intra-alveolar hemorrhage. Systemic disease, vasculitis and severe infections were excluded and the diagnosis of IPH was confirmed by lung biopsy revealing hemosiderin-laden macrophages in the alveoli.

Results: the patient received systemic glucocorticoids with a good and total response. Eight months later she was admitted because of fever, hemoptysis, marked inflammatory syndrome and leucopenia. Chest radiography and tomography were non-contributory. Bronchofibroscopy with direct exam for mycobacterium tuberculosis was positive. Under anti-tubercular therapy, the evolution was favorable.

Conclusion: lung tuberculosis associated to idiopathic pulmonary hemosiderosis is very rare. Immunodeficiency, corticotherapy as well as the underlying pulmonary lesions can support such an association.