Recovery of both acute massive pulmonary hemorrhage and acute renal failure in a systemic lupus erythematosus patient with lupus anticoagulant by the combined therapy of plasmapheresis plus cyclophosphamide.
Acute massive pulmonary hemorrhage (AMPH) is a rare and highly fatal complication in systemic lupus erythematosus (SLE). We report here survival in a case of AMPH in a SLE patient with both rapidly progressive glomerulonephritis and lupus anticoagulant. The AMPH occurred while the nephritis was refractory to 2 courses of pulse methylprednisolone therapy. After combined therapy with plasmapheresis plus cyclophosphamide, circulating immune complex levels declined, AMPH recovered, and serum creatinine levels returned to normal. In conclusion, the combined therapy of plasmapheresis plus cyclophosphamide should be considered for treating AMPH especially in those SLE patients with rapidly progressive glomerulonephritis.
Huang
D F
DF
Department of Medicine, Veterans General Hospital-Taipei, Taiwan.
Tsai
S T
ST
Wang
S R
SR
D000208:Acute Disease; D000328:Adult; D003131:Combined Modality Therapy; D003520:Cyclophosphamide / Q000627:therapeutic use*; D005260:Female; D005500:Follow-Up Studies; D005921:Glomerulonephritis / Q000150:complications / Q000188:drug therapy; D006470:Hemorrhage / Q000150:complications / Q000628:therapy*; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D008171:Lung Diseases / Q000150:complications / Q000628:therapy*; D016682:Lupus Coagulation Inhibitor / Q000097:blood; D008180:Lupus Erythematosus, Systemic / Q000150:complications* / Q000628:therapy; D008775:Methylprednisolone / Q000627:therapeutic use; D010956:Plasmapheresis; D051437:Renal Insufficiency / Q000150:complications / Q000628:therapy*