Research Article

Diffuse alveolar hemorrhage: Unusual presentation of systemic lupus erythematosus

Zajjari Yassir*, Sobhi Aya, Aatif Taoufiq, Azizi Mounia and El Kabbaj Driss

Published: 04/22/2021 | Volume 5 - Issue 1 | Pages: 031-033

Diffuse alveolar hemorrhage (DAH) is a rare complication of systemic lupus erythematosus (SLE) and carries a high mortality.

It was first described by Osler in 1904 as the most devastating pulmonary complication of SLE.

We describe a case of a 23-year-old girl recently diagnosed with SLE associated by a class III nephritis treated with oral corticoids and mycophenolate mofetil who developed a Diffuse Alveolar Hemorrhage DAH a few days later. The early diagnosis and the aggressive therapy allowed us to have a favorable outcome.

Read Full Article HTML DOI: 10.29328/journal.jcn.1001070 Cite this Article

References

  1. Zamora MR, Warner ML, Tuder R, Schwarz MI. Diffuse alveolar hemorrhage and systemic lupus erythematosus: clinical presentation, histology, survival, and outcome. Medicine. 1997; 76: 192-202. PubMed: https://pubmed.ncbi.nlm.nih.gov/9193454/
  2. Hunninghake GW, Fauci AS. Pulmonary involvement in the collagen vascular diseases. Am Rev Respir Dis.1979; 119: 471-503.
  3. Emlen W. Systemic lupus erythematosus and mixed connective tissue disease. Immunol Allergy Clin North America. 1993; 13: 291–311.
  4. Santiago-Casas Y, Vila LM. Pulmonary hemorrhage in patients with systemic lupus erythematosus. Curr Respir Med Rev. 2009; 5: 49-54.
  5. Kamen DL, Strange C. Pulmonary manifestations of systemic lupus erythematosus. Clin Chest Med. 2010; 31:479-488. PubMed: https://pubmed.ncbi.nlm.nih.gov/20692540/
  6. Koh WH, Thumboo J, Boey ML. Pulmonary haemorrhage in oriental patients with systemic lupus erythematosus. Lupus 1997; 6: 713–716.
  7. Badsha H, Teh CL, Kong KO, Lian TY, Chng HH. Pulmonary hemorrhage in systemic lupus erythematosus. Semin Arthritis Rheum 2004; 33: 414–421. PubMed: https://pubmed.ncbi.nlm.nih.gov/15190526/
  8. Olser W. On the visceral manifestations of the erythema group of skin diseases. Am J Med Sci. 2009; 338: 396–408. PubMed: https://pubmed.ncbi.nlm.nih.gov/19938295/
  9. Alabed LB. Treatment of Diffuse Alveolar Hemorrhage in Systemic Lupus Erythematosus Patient with Local Pulmonary Administration of Factor VIIa (rFVIIa) A Case Report. Medicine. 2014; 93: 14. PubMed: https://pubmed.ncbi.nlm.nih.gov/25255019/
  10. Liu MF, Lee JH, Weng TH, Lee YY. Clinical experience of 13 cases with severe pulmonary hemorrhage in systemic lupus erythematosus with active nephritis. Scand J Rheumatol. 1998; 27: 291–295.
  11. Martınez-Martınez MU, Abud-Mendoza C. Diffuse alveolar hemorrhage in patients with systemic lupus erythematosus. Clinical manifestations, treatment, and prognosis. Reumatol Clin. 2014; 10: 248–253.
  12. Marten K, Schnyder P, Schirg E, Prokop M, Rummeny EJ, et al. Pattern-based differential diagnosis in pulmonary vasculitis using volumetric CT. Am J Roentgenol 2005; 184: 720–733.
  13. Hoshi KI, Matsuda M, Ishikawa M, Mitsuhashi S, Gono T, et al. Successful treatment of fulminant pulmonary hemorrhage associated with systemic lupus erythematosus. Clin Rheumatol. 2004; 23: 252-255.
  14. Huang DF,Tsai TS, Wang SR. Recovery of both acute massive pulmonary hemorrhage and acute renal failure in a systemic lupus erythematosus patient with lupus anticoagulant by the combined therapy of plasmapheresis plus cyclophosphamide. Transfus Sci. 1994; 15: 283-288.
  15. Claridge S, Das P, Dorling A, Robson M. Plasmapheresis as rescue therapy for systemic lupus erthyematosus associated diffuse alveolar haemorrhage. BMJ Case Rep. 2011; 2011. PubMed: https://pubmed.ncbi.nlm.nih.gov/22698899/  
  16. Na JO, Chang SH, Seo KH, Sung Choi J, Sung Lee H. et al. Successful Early Rituximab Treatment in a Case of Systemic Lupus Erythematosus with Potentially Fatal Diffuse Alveolar Hemorrhage. Respiration. 2015; 89: 62–65.
  17. Estella A, Jareno A, Perez-Bello L. Intrapulmonary administration of recombinant activated factor VII in diffuse alveolar haemorrhage: a report of two case. Cases J. 2008 12; 1: 150. PubMed: https://pubmed.ncbi.nlm.nih.gov/18789132/