Idiopathic Pulmonary Haemosiderosis and Rheumatoid Arthritis

A four‐year‐old girl with cough, haemoptysis and anaemia

“…The present patient did not show any clinical evidence of SLE at the initial presentation, and 10 y later demonstrated SLE without pulmonary involvement. There have been six reported cases of pulmonary bleeding preceding other manifestations of connective tissue diseases (Table I) [4–9]. Compared to previously reported cases, the present patient had no pulmonary symptoms at the diagnosis of SLE.…”

“…Primary pulmonary haemosiderosis is classified into several forms: pure IPH, cow's milk allergy (Heiner's syndrome) and autoimmune disease accompanied by progressive glomerulonephritis (Goodpasture's syndrome) [2,3]. In contrast, secondary pulmonary haemosiderosis occurs in some patients concomitantly or subsequently to connective tissue diseases such as rheumatoid arthritis (RA) [4,5] or systemic lupus erythematosus (SLE) [6,7].…”

“…Compared to previously reported cases, the present patient had no pulmonary symptoms at the diagnosis of SLE. Two patients developed RA 8–13 y after the initial diagnosis of IPH [4,5]. In one of these patients, IPH was treated with azathioprine for 3 y [5].…”

“…All of the reported patients were diagnosed as having IPH at the initial presentation, because there were no clinical or laboratory findings suggestive of connective tissue diseases. Only one patient who developed RA more than 10 y after the onset of IPH presented without pulmonary bleeding at the diagnosis of RA [4].…”

Progressive systemic sclerosis complicated by diffuse pulmonary haemorrhage.

“…An association with rheumatoid arthritis has been found in a number of cases (Karlish, 1962;Ognibene and Dito, 1965;Smith, 1966). Two cases have been reported in which features of lupus erythematosus occurred five years and 18 months after a diagnosis of IPH had been made (Byrd and Trunk, 1973;Kuhn, 1972).…”