title: Successful rituximab therapy in a lupus patient with diffuse alveolar haemorrhage.
abstract: Diffuse alveolar haemorrhage (DAH) is a rare but life-threatening complication of systemic lupus erythematosus (SLE). Specific therapy is based on a heavy immunosuppressive treatment that usually associates corticosteroid and cyclophosphamide boluses and plasma exchange. Despite this treatment, an early mortality rate of 20-50% is reported in the literature. Immunosuppression-related complications are responsible for further mortality and morbidity. Rituximab, a specific anti-CD20 antigen B-cell antibody, has been used with success for the treatment of several refractory autoimmune disorders, but rarely for SLE-induced DAH. We report here the first case of SLE-induced DAH treated successfully with rituximab without cyclophosphamide administration in a patient intolerant to cyclophosphamide. We review the two other cases of SLE-induced DAH managed with rituximab as a part of the immunosuppressive regimen.
authors.affiliation: Département de Réanimation médicale et Médecine hyperbare, CHU Angers, Angers F-49933, France.
authors.forename: V
authors.initials: V
authors.lastname: Pottier
authors.forename: M
authors.initials: M
authors.lastname: Pierrot
authors.forename: J F
authors.initials: JF
authors.lastname: Subra
authors.forename: A
authors.initials: A
authors.lastname: Mercat
authors.forename: A
authors.initials: A
authors.lastname: Kouatchet
authors.forename: A
authors.initials: A
authors.lastname: Parrot
authors.forename: J F
authors.initials: JF
authors.lastname: Augusto
mesh_terms: D000293:Adolescent; D000328:Adult; D058846:Antibodies, Monoclonal, Murine-Derived / Q000627:therapeutic use*; D005260:Female; D006470:Hemorrhage / Q000188:drug therapy* / Q000209:etiology; D006801:Humans; D007155:Immunologic Factors / Q000627:therapeutic use*; D008180:Lupus Erythematosus, Systemic / Q000150:complications / Q000188:drug therapy*; D008297:Male; D008875:Middle Aged; D011650:Pulmonary Alveoli / Q000473:pathology; D000069283:Rituximab; D016896:Treatment Outcome
chemical_list: D058846:Antibodies, Monoclonal, Murine-Derived; D007155:Immunologic Factors; D000069283:Rituximab