title: Rituximab: an emerging treatment for recurrent diffuse alveolar hemorrhage in systemic lupus erythematosus.
abstract: Diffuse alveolar hemorrhage (DAH) is a rare manifestation of systemic lupus erythematosus (SLE) and is associated with high mortality rates. Treatment typically consists of aggressive immunosuppression with pulse-dose steroids, cyclophosphamide, and plasma exchange therapy. Mortality rates remain high despite use of multiple medical therapies. We present a case of recurrent DAH in a 52-year-old female with SLE after a deceased donor renal transplant who was successfully treated with rituximab. Our report highlights the pathophysiologic importance of B-cell-mediated immunosuppression in SLE-associated DAH and suggests that rituximab may represent a viable alternative to cyclophosphamide in the treatment of this disease. We also review eight other reported cases of rituximab use in SLE-associated DAH.
authors.affiliation: Department of Medicine, Division of General Internal Medicine.
authors.forename: J R
authors.initials: JR
authors.lastname: Tse
authors.affiliation: Department of Medicine, Division of General Internal Medicine.
authors.forename: K E
authors.initials: KE
authors.lastname: Schwab
authors.affiliation: Division of Rheumatology, David Geffen School of Medicine at University of California, Los Angeles, CA, USA.
authors.forename: M
authors.initials: M
authors.lastname: McMahon
authors.affiliation: Department of Medicine, Division of General Internal Medicine wsimon@mednet.ucla.edu.
authors.forename: W
authors.initials: W
authors.lastname: Simon
mesh_terms: D005260:Female; D006470:Hemorrhage / Q000188:drug therapy*; D006801:Humans; D007155:Immunologic Factors / Q000008:administration & dosage*; D008171:Lung Diseases / Q000188:drug therapy* / Q000473:pathology; D008180:Lupus Erythematosus, Systemic / Q000188:drug therapy* / Q000473:pathology / Q000503:physiopathology*; D008181:Lupus Nephritis / Q000503:physiopathology; D008875:Middle Aged; D011650:Pulmonary Alveoli / Q000473:pathology; D012008:Recurrence; D000069283:Rituximab / Q000008:administration & dosage*; D014657:Vasculitis / Q000503:physiopathology
chemical_list: D007155:Immunologic Factors; D000069283:Rituximab
keywords: Systemic lupus erythematosus; renal lupus; vasculitis