Diffuse Alveolar Hemorrhage A Rare but Serious Complication of Systemic Lupus Erythematosus

Introduction

Diffuse Alveolar Hemorrhage (DAH) is a severe yet uncommon manifestation of Systemic Lupus Erythematosus (SLE), presenting a significant challenge in patient management. While pulmonary involvement in SLE is well-documented, DAH remains a rare complication, occurring in only 1% to 5.4% of lupus cases. Early diagnosis and aggressive treatment are crucial for survival.

This article explores a case study of a 23-year-old woman with lupus nephritis who developed DAH, emphasizing the importance of timely medical intervention.

Case Overview

A 23-year-old woman was diagnosed with SLE-associated lupus nephritis (Class III) and treated with oral corticosteroids and mycophenolate mofetil (MMF). Despite early intervention, she developed hemoptysis, hypoxemia, and respiratory distress just eight days into treatment.

Clinical Findings & Diagnosis

• Symptoms: Fatigue, photosensitivity, polyarthralgia, and a malar rash
• Lab Tests:
  • Urinalysis: Proteinuria (2g/day), hematuria
  • Serology: Positive anti-nuclear antibody (ANA) & anti-double stranded DNA (dsDNA)
  • Low complement levels (C3 & C4)
• Imaging & Bronchoscopy:
  • Chest X-ray: Bilateral pulmonary infiltrates
  • CT scan: Diffuse alveolar opacities
  • Bronchoscopy: Blood-filled alveoli

The combination of rapid hemoglobin drop, bloody bronchoalveolar lavage, and progressive respiratory failure led to a confirmed DAH diagnosis.

Treatment Approach & Outcome

• MMF was discontinued due to worsening symptoms
• High-dose corticosteroids (IV methylprednisolone 1g/day for 3 days)
• Cyclophosphamide (1g IV infusion)
• Mechanical ventilation for 8 days

Recovery & Long-Term Plan:

• The patient responded well and was discharged after 26 days
• 5 more monthly cyclophosphamide doses were planned
• Maintenance therapy with prednisone & azathioprine helped prevent recurrence

Broader Implications

DAH is life-threatening, and its early detection is critical. It is commonly linked to active lupus nephritis, as seen in this case. Treatment involves:
High-dose corticosteroids
Immunosuppressants (Cyclophosphamide, Rituximab in some cases)
Plasmapheresis in refractory cases

The American College of Rheumatology (ACR) highlights the importance of aggressive immunosuppressive therapy in managing severe SLE complications【ACR】.

Key Takeaways

Read the full study: https://doi.org/10.29328/journal.jcn.1001070

Explore more nephrology research at: https://www.clinnephrologyjournal.org/jcn

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