"Difficult-to-treat" asthma-like symptoms in a 12-yr-old atopic female.

A 12-yr-old Caucasian female was referred to the pulmonary disease department in July 1997 for progressive on-exertion dyspnoea, persistent nonproductive cough and wheezing. Her symptoms had started 6 months prior to admission and moderately aggressive treatment with highdose inhaled steroids and short and long-acting b2-adrenoreceptor agonists, associated with short courses of oral prednisone therapy, had not produced any significant improvement. The most relevant data in her clinical history were the presence of a mild-to-moderate sensitivity to house dust mites (not associated, in the past, with significant respiratory symptoms) and the appearance in December 1996, after menarche, of iron-deficiency anaemia treated with oral iron tablets, containing ferrous sulphate 525 mg (Ferrograd1). On January 17, 1997 after ingestion of an iron tablet, she complained of sudden dyspnoea, chest pain and nonproductive cough. She was admitted to the accident and emergency department of another hospital and, as a result of a normal chest radiograph and a partial improvement of her symptoms after bronchodilator treatment, she was sent home on inhaled steroids and short-acting b2-adrenoreceptor agonists. Ten days later, while coughing, she finally expectorated a