Alveolar hemorrhage in systemic lupus erythematosus: presentation and management.
OBJECTIVE
To describe our experience with alveolar hemorrhage (AH) in systemic lupus erythematosus (SLE).


METHODS
Review of medical records and pertinent medical literature using MEDLINE and reference lists from retrieved publications.


METHODS
Seven patients with SLE admitted with episodes of AH (n = 11).


RESULTS
Six patients were female, and one was male. Mean age at the time of AH was 31.1 years. Mean duration of SLE was 4.5 years. AH occurred within 3 weeks of SLE onset in two patients. Recurrent AH was observed in four patients. Six patients were already receiving treatment for SLE at the time of AH. All patients presented with dyspnea and new pulmonary infiltrates. Hemoptysis occurred in only 54%. All patients had BAL within 48 h of presentation. Temperature > or =39 degrees C (102.2 degrees F) accompanied 82% of episodes. Glomerulonephritis was the most common nonpulmonary SLE manifestation (74%). Treatment with empiric IV antibiotics was initiated in 10 episodes. Initial treatment included high-dose corticosteroids (prednisone, 1 to 3 mg/kg/d [n = 2]; or IV methylprednisolone, 1 g/d [n = 9], with or without oral cyclophosphamide, 2 to 3 mg/kg/d [n = 7]). Plasmapheresis (three to four sessions) was added in five episodes for persistent AH. All patients survived.


CONCLUSIONS
AH may mimic pneumonia. Hemoptysis may not be evident. Infection must be aggressively excluded, especially since many patients with AH are already receiving immunosuppressive therapy. AH frequently recurs despite ongoing immunosuppression. Although high mortality rates have been reported with AH in SLE, we observed 100% survival.
Santos-Ocampo
A S
AS
Department of Medicine, Makati Medical Center, Makati City, Philippines.
Mandell
B F
BF
Fessler
B J
BJ
D000328:Adult; D000900:Anti-Bacterial Agents; D004333:Drug Administration Routes; D004359:Drug Therapy, Combination / Q000008:administration & dosage*; D005260:Female; D005938:Glucocorticoids / Q000008:administration & dosage*; D006470:Hemorrhage / Q000209:etiology* / Q000628:therapy; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage*; D008171:Lung Diseases / Q000209:etiology* / Q000628:therapy; D008180:Lupus Erythematosus, Systemic / Q000150:complications* / Q000628:therapy; D008297:Male; D010956:Plasmapheresis; D011650:Pulmonary Alveoli; D012189:Retrospective Studies; D016896:Treatment Outcome
D000900:Anti-Bacterial Agents; D005938:Glucocorticoids; D007166:Immunosuppressive Agents