Pulmonary haemorrhage and haemoptysis — clinical case

Case summary

This infant presents with the occult face of pulmonary haemorrhage: recurrent cough and tachypnoea with pallor, an iron-deficiency anaemia that will not respond to iron, and shifting bilateral infiltrates, with only coffee-ground vomit rather than frank haemoptysis. The essential insight is that a young child swallows rather than coughs up blood, so recurrent alveolar bleeding masquerades as anaemia and breathlessness, and his cow-milk-based feeding immediately raises the possibility of a milk-driven cause. ^{[3] [4]}