Pulmonary Hemosiderosis in a Young Child Presenting with Recurrent Respiratory illness and Refractory Anemia: A Case Report

Pulmonary hemosiderosis (PH) is a rare cause of diffuse alveolar hemorrhage in children and often presents with nonspecific respiratory symptoms and refractory iron‑deficiency anemia. We report a 2.5‑year‑old girl with recurrent lower respiratory tract infections, severe transfusion‑dependent anemia, failure to thrive, and persistent bilateral pulmonary infiltrates since infancy. Bronchoalveolar lavage demonstrated hemosiderin‑laden macrophages, confirming pulmonary hemosiderosis. Further evaluation revealed C‑ANCA positivity and PR3‑ANCA negativity, raising suspicion for an ANCA‑associated vasculitis; however, there was no renal, ear‑nose‑throat, or other systemic involvement, and a lung biopsy could not be performed. The child was managed with systemic corticosteroids with clinical improvement. This case highlights the diagnostic difficulty of pulmonary hemosiderosis in young children and emphasizes the need for cautious interpretation of isolated serological findings in the absence of definitive systemic features. Keywords: Pulmonary hemosiderosis, diffuse alveolar hemorrhage, C‑ANCA, iron deficiency anemia, child