A 6 year old refugee presented 1 day ago with impending type 2 respiratory failure, and was managed with intubation and mechanical ventilation.

During suction, active, fresh bleeding into the endotracheal tube was noted, even though intubation was non-traumatic; the bleeding subsided over time.

He has experienced multiple episodes of cough, wheezing, epistaxis, and cyanosis for the last 2 years. Detailed medical records are not available.

A complete blood count reveals microcytic anemia with a Hb of 10.9 and normal platelet counts, while a chest x-ray shows reticular-nodular opacification in the perihilar and basal regions

Blood and endotracheal aspirate cultures showed no growth, while a urinalysis, renal functions, liver functions, ECG, and echocardiogram were normal.