title: Diffuse alveolar hemorrhage in lupus nephritis complicated by microscopic polyangiitis.
abstract: Diffuse alveolar hemorrhage (DAH) is a rare but fatal complication in patients with systemic lupus erythematosus (SLE). We describe a case of a 74-year-old woman who presented with DAH as an initial presentation of SLE. She also had microscopic polyangiitis clinically manifesting as crescentic glomerulonephritis and purpura with positive myeloperoxidase (MPO)-antineutrophil cytoplasmic antibodies (ANCA). The patient transiently improved when treated with plasma exchange and methylprednisolone pulse therapy; however, she died of recurrent pulmonary hemorrhage and concurrent cryptococcal pneumonia. This case indicates that MPO-ANCA is associated with severe organ involvement such as pulmonary hemorrhage and crescentic glomerulonephritis in SLE.
authors.affiliation: Department of Medicine, Otsu Municipal Hospital, Otsu, Shiga 520-0804, Japan. isonom@mx3.canvas.ne.jp
authors.forename: Motohide
authors.initials: M
authors.lastname: Isono
authors.forename: Hisazumi
authors.initials: H
authors.lastname: Araki
authors.forename: Takao
authors.initials: T
authors.lastname: Haitani
authors.forename: Yoshikata
authors.initials: Y
authors.lastname: Morita
authors.forename: Mako
authors.initials: M
authors.lastname: Yasuda
authors.forename: Noriko
authors.initials: N
authors.lastname: Kato
authors.forename: Koji
authors.initials: K
authors.lastname: Urasaki
authors.forename: Yoshinori
authors.initials: Y
authors.lastname: Tsujimura
mesh_terms: D000368:Aged; D019268:Antibodies, Antineutrophil Cytoplasmic / Q000097:blood; D017809:Fatal Outcome; D005260:Female; D006470:Hemorrhage / Q000209:etiology; D006801:Humans; D008171:Lung Diseases / Q000209:etiology; D008181:Lupus Nephritis / Q000150:complications* / Q000628:therapy; D008775:Methylprednisolone / Q000627:therapeutic use; D055953:Microscopic Polyangiitis / Q000209:etiology*; D009195:Peroxidase / Q000276:immunology; D010951:Plasma Exchange; D011650:Pulmonary Alveoli
chemical_list: D019268:Antibodies, Antineutrophil Cytoplasmic; D009195:Peroxidase; D008775:Methylprednisolone