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Lung hemorrhage


There have been several recent questions about the group of infants from Cleveland who died due to a fungal infection associated with repeated episodes of marked bleeding from the lungs. Although SIDS was considered as an explanation for a few of the deaths, the clinical course was quite different from SIDS.

This fungal infection has not been previously reported as a cause of disease in infants. It is associated with homes affected by water damage. In all instances, this infection was associated with multiple episodes of marked bleeding from the lungs.

The important message to emphasize is that this kind of lung hemorrhage is not related to the relatively modest amounts of bleeding from the airways and lungs that have often been observed by SIDS parents.

I hope this is helpful.

Dr. Carl Hunt
Washington, DC/Toledo

Date: Fri, 18 Apr 1997 13:10:32 -0700

Idiopathic pulmonary hemosiderosis (IPH) is a rare disease of the lungs characterized by intermittent hemorrhages from the lungs. In some cases, these are quite dramatic, and can result in death from blood loss and "drowning" in the blood in the lungs. More frequently, the hemorrhage can occur slowly, and may not even be noticed. However, these patients eventually can become anemic and/or the slow bleeding causes scarring in the lungs, which eventually causes respiratory failure. In general, the cause is unknown. IPH can affect infants.

Over the past few years, there have been a relatively large number of IPH babies in the Cleveland area. The CDC was called in to help understand why. They believe that the Cleveland cases are caused by inhalation of a type of mold or fungus which grows in wet basements in that area. There is no consensus at present about whether IPH in areas other than Cleveland are also caused by this mold. Outside the Cleveland area, IPH remains a rare disorder.

IPH could certainly cause death. In general, one would expect that the pulmonary hemorrhage would be evident on autopsy, and thus these babies would have a cause of death determined to be IPH rather than SIDS. However, I do know that some babies being treated for IPH died and were signed out by the Coroner as having died from SIDS. I would think that if a baby has IPH, then pulmonary hemorrhage should be obvious, and the diagnosis of SIDS would not be used. However, I do not know the details of these deaths, therefore I can not comment further.

Regrettably, I did not watch the television show where this issue was brought up. Therefore, I am not certain exactly what was said. However, I think it is safe tyo say that IPH is not the cause of SIDS.

I hope this helps. Thank you.

---Tom Keens
Childrens Hospital Los Angeles

In my many years of experience of reviewing SIDS postmortem case material (gross descriptions and microscopic slides of the lungs), I have never seen a case of pulmonary hemosiderosis mistaken for SIDS. The pathology and clinical histories of pulmonary hemosiderosis differ dramatically from SIDS, and would be difficult to confuse even by an experienced pathologist.

Henry Krous
Children's Hospital - San Diego

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