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Abstract
Case 1: A 28-year-old Mestizo female with diffuse alveolar hemorrhage A 28-year-old Mestizo female was diagnosed with systemic lupus erythematosus (SLE) a year ago, based on fever, polyarthralgia/its, malar rash, oral ulcers and proteinuria of 2200 mg/24 h. Antinuclear antibodies, anti-double stranded DNA, and anti-Sm antibodies were all positive, with C3 and C4 hypocomplementemia. Her SLEDAI score was 16. A kidney biopsy revealed Class III lupus nephritis, with scores of 9 and 2 for activity and chronicity, respectively. She was treated successfully with pulses of methylprednisolone and cyclophosphamide followed by prednisone 40 mg/day (subsequently tapered), hydroxychloroquine 400 mg/day, mycophenolate mofetil, calcium and vitamin D.
In November 2023 she was admitted to hospital following a few days of fever, paleness, cough, dyspnea, and thoracic pain. On admission she presented hypotension and pulmonary crackles. Blood analysis showed leukopenia, lymphopenia, thrombocytopenia, and a 1.5 g/dL drop in hemoglobin level (compared to her previous one taken 20 days before), C3 and C4 hypocomplementemia and proteinuria of 1800 mg/24 h. A chest X-ray and thoracic CT scan showed bilateral patchy infiltrates and ground glass opacities. A bronchoalveolar lavage fluid was performed and revealed hemosiderin-laden macrophages. All cultures were sterile. With a diagnosis of acute diffuse alveolar hemorrhage (DAH), she was treated with pulse of methylprednisolone and cyclophosphamide. Treatment with plasmapheresis and rituximab was not necessary due to her favourable progress.1–3
References
Al-Adhoubi NK, Bystrom J. Systemic lupus erythematosus and diffuse alveolar hemorrhage, etiology and novel treatment strategies. Lupus. 2020;29(4):355–63. doi: 10.1177/0961203320903798.
Martínez-Martínez MU, Oostdam DAH, Abud-Mendoza C. Diffuse alveolar hemorrhage in autoimmune diseases. Curr Rheumatol Rep. 2017;19(5):27. doi: 10.1007/s11926-017-0651-y.
Sun Y, Zhou C, Zhao J, et al. Systemic lupus erythematosus-associated diffuse alveolar hemorrhage: a single-center, matched case-control study in China. Lupus. 2020;29(7):795–803. doi: 10.1177/0961203320920715.
Learning Objectives At the end of this workshop participants will be able to:
Describe the clinical presentation of DAH
Discuss complication and differential diagnosis with allied diseases
Discuss the treatment of DAH
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