[Pleuropulmonary manifestations of systemic lupus erythematosus].
OBJECTIVE
To analyze the incidence, clinical features, and prognosis of pleuropulmonary involvement in patients with systemic lupus erythematosus (SLE).


METHODS
The medical records of 320 SLE inpatients hospitalized in Peking Union Medical College Hospital 2004, 50 males and 270 females, aged 33 +/- 14 (8-75), were retrospectively analyzed.


RESULTS
Pleuropulmonary involvement occurred in 142 cases with an incidence rate of 44.4%. The incidence of pleural involvement was 25% (80/320) and the incidence of pulmonary parenchyma involvement was 33.8% (108/320). The mortality rate of the SLE patients with thoracic involvement was 7.0%, significantly higher than that of the SLE patients without thoracic involvement (1.0%, P = 0.006). The incidence of acute lupus pneumonitis (ALP) was 1.3% and the survival rate of ALP was 100%. The clinical manifestations of ALP included hypoxemia, dyspnea, fever, and cough and chest radiograph characteristically showed unilateral or bilateral patchy acinar infiltrates predominantly in the lower lung zone. The incidence of diffuse alveolar hemorrhage (DAH) was 1.9% with a mortality rate of 66.7%. The clinical manifestations of DAH included hemoptysis, hypoxemia, cough, anemia and bloody bronchoalveolar lavage and the chest radiographic findings included new acinar infiltrates that were typically diffuse and bilateral and might be patchy. The other common pleuropulmonary complications of SLE included pleural disease (25%), chronic interstitial pneumonitis (6.9%), pulmonary hypertension (15.3%), pulmonary embolism (1.9%), and pulmonary infection (19.1%).


CONCLUSIONS
SLE may affect all components of the respiratory system. Thoracic involvement is an adverse prognostic sign. Life-threatening pulmonary involvement is not uncommon. The clinicoradiographic features of the SLE-associated pulmonary syndromes overlap. Aggressive diagnostic evaluations such as blood culture, sputum culture, fibreoptic bronchoscopy, and lung biopsy are very important.
Shen
Min
M
Department of Rheumatology and Immunology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Science, Beijing 100730, China.
Wang
Yu
Y
Xu
Wen-bing
WB
Zeng
Xue-jun
XJ
Zhang
Feng-chun
FC
D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D002681:China / Q000453:epidemiology; D005260:Female; D006801:Humans; D015994:Incidence; D008171:Lung Diseases / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology*; D008180:Lupus Erythematosus, Systemic / Q000150:complications*; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012189:Retrospective Studies