Presentation
The patient initially presented with dyspnoea and pyrexia.
Patient Data
Chest X-ray demonstrates bilateral, air space changes in upper, mid, and lower zones right greater than left. There is no dense lobar consolidation or collapse. The CTR is normal. There are no radiopaque foreign bodies identified. The child was treated for bronchopneumonia at this presentation.
Portable seated chest X-ray demonstrates mid to lower zonal air space changes.
This appears persistent but improved in comparison to the X-ray 16 months earlier.
There is no dense collapse or lobar consolidation.
There is rotation at the time of exposure.
There are bilateral, multifocal ground-glass opacities involving all lobes.
There is a developing nodular appearance within the left lower lobe.
There is no crazy paving, no dense collapse, no lobar consolidation, and no interstitial fibrosis.
There are no pleural effusions, and no pulmonary infarcts.
Reformats confirm multifocal, bilateral, ground-glass opacities.
There is no dense lobar pneumonia and no well-defined circumscribed nodules or masses.
There were no suspicious vascular abnormalities on contrast administration.
There were no suspicious or CT significant hilar or mediastinal lymph nodes additionally.
There is normal opacification of the heart, pulmonary vasculature, and thoracic aorta.
Case Discussion
At the first presentation during the first SARS-CoV- 2 wave, the child was treated for bronchopneumonia.
SARS CoV-2-RT-PCR was confirmed negative.
Chronic anaemia was discovered on haematological analysis, however, no apparent cause was identified on full workup.
On readmission 16 months later (during the 3rd wave) the child was severely anaemic and repeat investigations were done.
HRCT confirmed ground-glass opacities and idiopathic pulmonary haemosiderosis was suggested as a likely cause of presentation.
Again the child tested negative for SARS-CoV-2.
Stool for occult blood was negative, however clinical suspicion of possible cow's milk allergy was suspected and a restricted diet was recommended in addition to the medical management of immunosuppressive and steroid therapy.
A bronchoscopic biopsy would be confirmative however was deferred and planned only if there was a poor response to medical management.
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