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Diffuse alveolar hemorrhage in Colombian patients with systemic lupus erythematosus

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Abstract

Diffuse alveolar hemorrhage (DAH) is a rare life-threatening complication seen in patients with systemic lupus erythematosus (SLE). This paper describes the clinical features and outcome of seven SLE patients with DAH admitted to a medical intensive care unit (ICU) in a referral center. Of a total of 122 SLE patients, seven patients presented this complication (5.7%). Five patients were women (71.4%). Mean age was 24.3 (range 4–51 years). Mean duration of SLE before clinical DAH was 15.7 months (range 0–48 months). DAH was the initial manifestation of SLE in two patients (29%). DAH recurrence was seen in two patients (29%). Active lupus was present in all seven patients. Fever, glomerulonephritis, arthritis, myositis, and peripheral neuropathy were observed in six, four, four, three, and two patients, respectively. Five patients who underwent to bronchoscopy had positive findings of DAH (71.4%; i.e., bloody return on bronchoalveolar lavage—with hemosiderin-laden macrophages). Treatment options included intravenous methylprednisolone (10 mg kg−1 day−1—3 days) following by prednisolone 1 mg kg−1 day−1 and pulse cyclophosphamide (750 mg/m2). Plasmapheresis was added in four patients (57.1%) because of the persistence of DAH. All patients were treated in an ICU, six of them requiring mechanical respiratory support (85.1%). Mortality rate during ICU stay was 12% (one patient). Our results show that DAH is an uncommon complication in SLE patients, requiring a prompt and aggressive recognition and treatment with high-dose steroid, intravenous cyclophosphamide, and plasmapheresis. With all of these treatments, there is a trend to a low mortality rate in patients with SLE presenting DAH.

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References

  1. Osler W (1904) On the visceral manifestations of erythema group of skin disease. Am J Med Sci 127:1–23

    Article  Google Scholar 

  2. Iglesias-Gamarra A (2003) Historia de las manifestaciones pulmonares. In: Historia del Lupus. Panamericana pp 361–388

  3. Abud-Mendoza C, Diaz-Jouanen E, Alarcón-Segovia D (1985) Fatal pulmonary hemorrhage in systemic lupus erythematosus. Ocurrence without hemoptysis. J Rheumatol 12:558–561

    PubMed  CAS  Google Scholar 

  4. Eagen JW, Memoli VA, Roberts JL et al (1978) Pulmonary hemorrhage in systemic lupus erythematosus. Medicine 57:545–560

    Article  PubMed  CAS  Google Scholar 

  5. Mintz G, Galindo LF, Fernandez-Diaz J et al (1978) Acute massive pulmonary hemorrhage in systemic lupus erythematosus. J Rheumatol 5:39–50

    PubMed  CAS  Google Scholar 

  6. Myers JL, Katzenstein AL (1986) Microangiitis in lupus-induced pulmonary hemorrhage. Am J Clin Pathol 85:552–556

    PubMed  CAS  Google Scholar 

  7. Barile LA, Jara LJ, Medina-Rodriguez F et al (1997) Pulmonary hemorrhage in systemic lupus erythematosus. Lupus 6:445–448

    PubMed  CAS  Google Scholar 

  8. Koh WH, Thumboo J, Boey ML (1997) Pulmonary hemorrhage in oriental patients with systemic lupus erythematosus. Lupus 6:713–716

    PubMed  CAS  Google Scholar 

  9. Liu MF, Lee JH, Weng TH et al (1998) Clinical experience of 13 cases with severe pulmonary hemorrhage in systemic lupus erythematosus with active nephritis. Scand J Rheumatol 27:291–295

    Article  PubMed  CAS  Google Scholar 

  10. Schwab EP, Schumacher HR, Freundlich B et al (1993) Pulmonary alveolar hemorrhage in systemic lupus erythematosus. Semin Arthritis Rheum 23:8–15

    Article  PubMed  CAS  Google Scholar 

  11. Santos-Ocampo AS, Mandell BF, Fessler BJ (2000) Alveolar hemorrhage in systemic lupus erythematosus. Chest 118:1083–1090

    Article  PubMed  CAS  Google Scholar 

  12. Hochberg MC (1997) Updating the American College of Rheumatology revised criteria for the classification of systemic lupus erythematosus. Arthritis Rheum 40:1725

    Article  PubMed  CAS  Google Scholar 

Download references

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Correspondence to Carlos Cañas.

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Cañas, C., Tobón, G.J., Granados, M. et al. Diffuse alveolar hemorrhage in Colombian patients with systemic lupus erythematosus. Clin Rheumatol 26, 1947–1949 (2007). https://doi.org/10.1007/s10067-007-0576-3

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  • DOI: https://doi.org/10.1007/s10067-007-0576-3

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