Abstract A 17 month old boy with history of prematurity born at 35 weeks gestation was on vacation the summer of 2025 and presented to a local hospital following an episode of hematemesis. He was found to have a hemoglobin of 3.6 and transferred to a tertiary care center, where hemoglobin had further dropped to 2.8. Testing was positive for adenovirus, with presence of bilateral chest infiltrates on radiograph. He was transfused and discharged home on iron supplementation, with a presumptive diagnosis of anemia due to excessive milk intake, although parents did not report intake of greater than 12 fluid oz per day. He followed up in our Hematology clinic, where serial hemoglobin was obtained and increased to 9.2, but again presented to the Emergency Department in August following a second episode of hematemesis. Hemoglobin had dropped to 7.4, for which he was transfused. Liver ultrasound with doppler and bubble echocardiogram were completed and were reassuring. Viral testing was positive for rhino/enterovirus, and bilateral infiltrates were again demonstrated on CXR. There was consideration of inpatient flexible bronchoscopy and EGD, but this was deferred due to viral positivity. He was discharged home with plan for close outpatient follow up. Throughout both hospital admissions, the patient did not have cough, difficulty breathing, hemoptysis, or hypoxia. He followed up in Pulmonary clinic 3 weeks following hospital discharge. The decision was made to pursue bronchoscopy and EGD. Flexible bronchoscopy was notable for mild bronchitis, with pink tinged return of fluid and 99% hemosiderin-laden macrophages on BAL, in addition to RBCs, suggestive of ongoing bleeding. He was subsequently started on 1mg/kg prednisolone for a presumed diagnosis of idiopathic pulmonary hemosiderosis. He was evaluated by Rheumatology. ANA, ANCA, ENA, and TTG IgA were negative, and complement testing was normal. The plan was made to continue steroids through the winter months, increasing to 2mg/kg daily during times of illness. Hemoglobin normalized. CT was obtained and demonstrated a small area of traction bronchiectasis, scattered ground glass opacities, and consolidative opacities. Our case is notable because while the average hemoglobin in patients with IPH is in the 7-8gm/dL range, our patient’s initial hemoglobin was 2.8, yet he remained completely asymptomatic from a respiratory standpoint. This case serves as an important reminder that IPH should be considered in the differential of patients with severe anemia of undetermined etiology and radiographic infiltrates, even in the absence of respiratory symptoms. This abstract is funded by: None
Agnihotri et al. (Fri,) studied this question.