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A disorder of surfactant metabolism without identified genetic mutations.


ABSTRACT:

Background

Surfactant metabolism disorders may result in diffuse lung disease in children.

Case presentation

We report a 3-years-old boy with dry cough, progressive hypoxemia, dyspnea and bilateral ground glass opacities at chest high-resolution computed tomography (HRCT) who had no variants in genes encoding surfactant proteins or transcription factors. Lung histology strongly suggested an abnormality of surfactant protein. A 7-month course of pulse intravenous high-dose methylprednisolone plus oral hydroxychloroquine and azithromycin led to gradual weaning from oxygen and oral steroids, and to improvement of cough and dyspnea. Over the follow-up period, hydroxychloroquine and azithromycin were not withdrawn as cough and dyspnea re-appeared at each attempt and disappeared at re-start. At 6 years of age chest HRCT still appeared unchanged, but clinical symptoms or signs were absent.

Conclusions

In children suspected of inborn errors of pulmonary surfactant metabolism who do not have a recognized genetic mutation, lung biopsy with consistent histology may help physicians to address the definitive diagnosis.

SUBMITTER: Montella S 

PROVIDER: S-EPMC4658764 | biostudies-literature | 2015 Nov

REPOSITORIES: biostudies-literature

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A disorder of surfactant metabolism without identified genetic mutations.

Montella Silvia S   Vece Timothy J TJ   Langston Claire C   Carrera Paola P   Nogee Lawrence M LM   Hamvas Aaron A   Manna Angelo A   Cervasio Mariarosaria M   Santamaria Francesca F  

Italian journal of pediatrics 20151125


<h4>Background</h4>Surfactant metabolism disorders may result in diffuse lung disease in children.<h4>Case presentation</h4>We report a 3-years-old boy with dry cough, progressive hypoxemia, dyspnea and bilateral ground glass opacities at chest high-resolution computed tomography (HRCT) who had no variants in genes encoding surfactant proteins or transcription factors. Lung histology strongly suggested an abnormality of surfactant protein. A 7-month course of pulse intravenous high-dose methylpr  ...[more]

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