Acute massive pulmonary hemorrhage after craniotomy in a patient with systemic lupus erythematosus.
Acute massive pulmonary hemorrhage (AMPH) is a rare life-threatening complication of systemic lupus erythematosus (SLE). We report a lupus nephritis patient with active disease, in whom AMPH developed after craniotomy for brain injury. Computed tomography scan of the brain revealed a subdural hemorrhage and intracranial hemorrhage with a midline shift, indicating increased intracranial pressure (IICP). Neurogenic pulmonary edema (NPE) was suspected 5 days after operation due to dyspnea and chest radiograph findings of bilateral infiltrations. Seven days after the craniotomy, she had bloody sputum, a sudden drop in blood hemoglobin level (from 12.3 g/dL to 8.8 g/dL), and diffuse alveolar infiltrates in both lung fields. All of these features were characteristic manifestations of AMPH. Complete blood count disclosed mild thrombocytopenia (88,000/mm3). We believe that in an SLE patient, IICP or NPE might be risk factors in the development of AMPH.
Chang
Shu-Jen
SJ
Section of Allergy, Immunology, and Rheumatology, Department of Medicine, Cheng Hsin Rehabilitation Medical Center, Taipei, Taiwan.
Yen
Yu-Shu
YS
Huo
An-Ping
AP
Lee
Shinn-Shing
SS
Huang
De-Feng
DF
D003399:Craniotomy / Q000009:adverse effects*; D005260:Female; D006470:Hemorrhage / Q000209:etiology*; D006801:Humans; D007427:Intracranial Pressure; D008171:Lung Diseases / Q000209:etiology*; D008180:Lupus Erythematosus, Systemic / Q000150:complications*; D008875:Middle Aged; D011654:Pulmonary Edema / Q000150:complications