Pulmonary hemosiderosis in children with Down syndrome: a national experience

Aurelia Alimi,
Jessica Taytard,
Rola Abou Taam,
Véronique Houdouin,
Aude Forgeron,
Marc Lubrano Lavadera,
Pierrick Cros,
Isabelle Gibertini,
Jocelyne Derelle,
Antoine Deschildre,
Caroline Thumerelle,
Ralph Epaud,
Philippe Reix,
Michael Fayon,
Sylvie Roullaud,
Françoise Troussier,
Marie-Catherine Renoux,
Jacques de Blic,
Sophie Leyronnas,
Guillaume Thouvenin,
Caroline Perisson,
Aimé Ravel,
Annick Clement,
Harriet Corvol,
Nadia NathanEmail author View ORCID ID profile and
for the French RespiRare® group

Orphanet Journal of Rare Diseases201813:60

https://doi.org/10.1186/s13023-018-0806-6

Received: 2 October 2017

Accepted: 12 April 2018

Published: 20 April 2018

Abstract

Background

Pulmonary hemosiderosis is a rare and complex disease in children. A previous study from the French RespiRare® network led to two important findings: 20% of the children presented with both pulmonary hemosiderosis and Down syndrome (DS), and at least one tested autoantibody was found positive in 50%. This study investigates the relationships between pulmonary hemosiderosis and DS.

Methods

Patients younger than 20 years old and followed for pulmonary hemosiderosis were retrieved from the RespiRare® database. Clinical, biological, functional, and radiological findings were collected, and DS and non-DS patients’ data were compared.

Results

A total of 34 patients (22 girls and 12 boys) were included, among whom nine (26%) presented with DS. The mean age at diagnosis was 4.1 ± 3.27 years old for non-DS and 2.9 ± 3.45 years old for DS patients. DS patients tended to present a more severe form of the disease with an earlier onset, more dyspnoea at diagnosis, more frequent secondary pulmonary hypertension, and an increased risk of fatal evolution.

Conclusions

DS patients have a higher risk of developing pulmonary hemosiderosis, and the disease seems to be more severe in this population. This could be due to the combination of an abnormal lung capillary bed with fragile vessels, a higher susceptibility to autoimmune lesions, and a higher risk of evolution toward pulmonary hypertension. A better screening for pulmonary hemosiderosis and a better prevention of hypoxia in DS paediatric patients may prevent a severe evolution of the disease.