Pulmonary capillaritis in children

Pulmonary capillaritis in children Pulmonary hemorrhage in children is a rare but serious condition which can be focal or diffuse. In this issue of The Journal, Fullmer and colleagues from Baylor College of Medicine review the pathological features of 23 children who underwent lung biopsy for pulmonary hemorrhage. They were searching for cases of pulmonary capillaritis (PC), a condition described first in 1957 in patients with systemic vasculitis, and since reported in children with conditions such as Churg-Strauss syndrome and microscopic polyangiitis. Eight cases of PC were identified and compared with the remaining patients. The patients with PC presented with coughing, crackles and hypoxia; 50% of the cases had evidence of a systemic vasculitis and they all responded to corticosteroid treatment. Unfortunately, there were no clinical features that would serve to distinguish PC from other causes of diffuse alveolar hemorrhage, and therefore lung biopsy is recommended early in the course of investigating diffuse alveolar hemorrhage. —Robert W. Wilmott, MD page 376

Ameliorating inflammation associated with obesity There has been much interest in inflammatory processes as a new risk factor for cardiovascular disease. It has also been demonstrated that overweight and obesity are associated with increased inflammation as measured by elevated circulatory concentrations of C- reactive protein, fibrinogen, and interleukin-6. It is not clear if intervention to improve lifestyle and reduce overweight are successful in reducing the inflammatory process. In this issue of The Journal, Balagopal et al report the results of a randomized controlled study of lifestyle intervention. The intervention lasted 3 months and included weekly nutritional counseling and 45 minutes of physical activity 3 times per week. They found that the intervention group maintained their weight while the usual care group gained weight. Elevated markers of inflammation were reduced in the intervention group but not the control group. In an editorial, Steinberger points out that these results emphaisize that even modest lifestyle changes can have important beneficial effects. This should provide useful evidence for those who are implementing these lifestyle changes in a primary care setting. —Stephen R. Daniels, MD, PhD page 342

The Journal of Pediatrics

March 2005

3A