Diffuse cutaneous systemic sclerosis associated with pan-serositis, disseminated intravascular coagulation, and diffuse alveolar haemorrhage

organisms and no malignant cells were detected. Bronchoalveolar lavage fluid (BALF) from right B 5 bronchus was slightly haemorrhagic. Nucleated cell count of BALF was 2.5 x 105 cells ml-1 and the cellular components were alveolar macrophage; 5.0%, lymphocyte; 3'3%, neutrophil; 91.3%, and eosinophils; 0.3%. Because the patient was critically ill, transbronchial lung biopsy was not performed. For lung damage and pan-serositis (pleuritis, pericarditis, and peritonitis) probably due to SS, she was treated with methyl-prednisolone (initial dose 1"000 mg day 1) after skin biopsy on the 3rd day.