title: Pulmonary hemorrhage in a patient initially presenting with discoid lupus.
abstract: As a cutaneous variant of lupus erythematosus, discoid lupus erythematosus (DLE) is thought to have a good prognosis; however, the involvement of internal organs with a transition to systemic disease may occur. The progression from DLE to systemic lupus erythematosus has been reported in up to 28% of patients. This progression to systemic disease has been associated with a benign course. Herein, we report the case of a 31-year-old woman with a 10-year history of discoid lupus, now presenting with dyspnea and pleuritic chest pain of 1 month's duration. A significant drop in hemoglobin and hematocrit levels was observed in association with leukopenia, lymphopenia, a positive ANA, and hypocomplementemia. Chest radiography and computed tomography revealed bilateral infiltrates. An open lung biopsy confirmed the presence of intra-alveolar hemorrhage. Based on the results of the tests and analyses detailed herein, a diagnosis of pulmonary hemorrhage secondary to systemic lupus erythematosus was made. To our knowledge, pulmonary hemorrhage as the initial manifestation of the systemic involvement of discoid lupus has not been reported before.
authors.forename: Karina
authors.initials: K
authors.lastname: Vilá-Rivera
authors.affiliation: Division of Rheumatology, University of Puerto Rico Medical Sciences Campus, San Juan, Puerto Rico.
authors.forename: Esther
authors.initials: E
authors.lastname: Jiménez-Encarnación
authors.forename: Salvador
authors.initials: S
authors.lastname: Vilá
mesh_terms: D000328:Adult; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001706:Biopsy; D001996:Bronchopneumonia / Q000175:diagnosis; D003951:Diagnostic Errors; D018450:Disease Progression; D004417:Dyspnea / Q000209:etiology; D005260:Female; D006470:Hemorrhage / Q000097:blood / Q000000981:diagnostic imaging / Q000209:etiology* / Q000473:pathology; D006801:Humans; D006886:Hydroxychloroquine / Q000627:therapeutic use; D007970:Leukopenia / Q000209:etiology; D008171:Lung Diseases / Q000097:blood / Q000000981:diagnostic imaging / Q000209:etiology* / Q000473:pathology; D008179:Lupus Erythematosus, Discoid / Q000150:complications*; D008180:Lupus Erythematosus, Systemic / Q000150:complications; D011241:Prednisone / Q000627:therapeutic use; D011859:Radiography; D020775:Thoracic Surgery, Video-Assisted
chemical_list: D000900:Anti-Bacterial Agents; D006886:Hydroxychloroquine; D011241:Prednisone