Alveolar hemorrhage in systemic lupus erythematosus: An overview

Abstract Introduction Alveolar hemorrhage (AH) is a rare, but serious manifestation of SLE. It may occur early or late in disease evolution. Extrapulmonary disease may be minimal and may be masked in patients who are already receiving immunosuppressants for other symptoms of SLE. The capacity of AH to occur and recur despite ongoing immunosuppressive therapy is emphasized. Aim of the work Reporting our experience with alveolar hemorrhage in patients with systemic lupus erythematosus. Patients and methods Records of SLE patients admitted between years 2000 and 2008 were reviewed. Seven patients with SLE admitted with nine episodes of AH were found. For all study subjects, the pertinent demographic, clinical, laboratory, histologic, therapeutic and outcome data were abstracted and chest X-ray reviewed. The disease activity was assessed using SLEDAI. Results and Conclusion The seven patients were females. Their age ranged from 17 to 35 years and disease duration ranged from 4 to 48 months. AH occurred within 4 months of SLE onset in two patients. All patients presented with hemoptysis, new pulmonary infiltrates and hemoglobin drop. Glomerulonephritis was the most common extrapulmonary SLE manifestation (85%). Initial treatment included IV methylprednisolone in all cases (100%), with cyclophosphamide in four episodes. Plasmapheresis (one session) was done in only one episode. Survival rate was 14%. Conclusion Alveolar hemorrhage is a rare but lethal complication of SLE and represents a remarkable challenge. It should be diagnosed promptly with falling red cell indices and new infiltrates on chest radiograph. It occurs in vicinity of active disease. Lupus nephritis is most associated manifestation. Alveolar hemorrhages frequently recur despite ongoing immunosuppressant therapy. Early treatment with intra venous (IV) pulse methylprednisolone and IV cyclophosphamide should be instituted for a better outcome.