title: Venous thromboembolism with concurrent pulmonary haemorrhage in systemic vasculitis.
abstract: BACKGROUND
  Pulmonary haemorrhage (PH) is a serious manifestation of systemic vasculitis with high mortality rates yet vasculitis is associated with an increased prevalence of venous thromboembolism (VTE). The concurrent presentation of severe PH and VTE poses a challenge in terms of therapeutic management.
  
  
  METHODS
  This is a retrospective case review of the clinical manifestations and response to treatment in vasculitis patients presenting with concurrent pulmonary haemorrhage and VTE (pulmonary embolism and/or deep venous thrombosis).
  
  
  RESULTS
  Of 35 patients with severe PH due to systemic vasculitis, 7 (20%) had concurrent VTE. The most common cause was anti-neutrophil cytoplasm antibody-associated vasculitis, followed by anti-glomerular basement membrane disease. Vasculitis responded to conventional therapies and VTE treatment with anticoagulation was uncomplicated in five of six cases. In one case, anticoagulation precipitated the PH and another was not anticoagulated and developed recurrent VTE. All patients survived without further complications after a mean follow-up of 46 months (3-98).
  
  
  CONCLUSIONS
  Concurrent VTE occurred in one-fifth of cases with severe PH due to vasculitis. Management of VTE with anticoagulation was effective but led to pulmonary haemorrhage in one patient.
authors.affiliation: Vasculitis and Lupus Clinic, Addenbrooke’s Hospital, Cambridge, UK. erikades4@gmail.com
authors.forename: Erika
authors.initials: E
authors.lastname: De Sousa
authors.forename: Rona
authors.initials: R
authors.lastname: Smith
authors.forename: Afzal
authors.initials: A
authors.lastname: Chaudhry
authors.forename: Lisa
authors.initials: L
authors.lastname: Willcocks
authors.forename: David
authors.initials: D
authors.lastname: Jayne
mesh_terms: D000293:Adolescent; D005260:Female; D006470:Hemorrhage / Q000150:complications* / Q000209:etiology; D006801:Humans; D008171:Lung Diseases / Q000150:complications* / Q000209:etiology; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012720:Severity of Illness Index; D056647:Systemic Vasculitis / Q000150:complications*; D054556:Venous Thromboembolism / Q000150:complications* / Q000209:etiology; D055815:Young Adult