Alveolar hemorrhage in systemic lupus erythematosus: a cohort review

Andrade, Carla Sousa; Mendonça, Teresa; Farinha, Fátima; Correia, João; Marinho, António; Almeida, Isabel; Vasconcelos, Carlos

doi:10.1177/0961203315605365

Cited by 64 publications

(59 citation statements)

References 25 publications

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“…Clinically, it manifests as dyspnea, cough, and hemoptysis (may be absent in as much as 30% of patients) and usually coexists with lupus nephritis [13,86]. In a significant proportion of patients, severe respiratory failure may develop, requiring ventilatory support and intensive care unit stay [87].…”

Section: Dah Syndromesmentioning

confidence: 99%

Acute Respiratory Events in Connective Tissue Disorders

Papiris¹,

Manali²,

Kolilekas³

et al. 2016

Respiration

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Subacute-acute, hyperacute, or even catastrophic and fulminant respiratory events occur in almost all classic connective tissue disorders (CTDs); they may share systemic life-threatening manifestations, may precipitously lead to respiratory failure requiring ventilatory support as well as a combination of specific therapeutic measures, and in most affected patients constitute the devastating end-of-life event. In CTDs, acute respiratory events may be related to any respiratory compartment including the airways, lung parenchyma, alveolar capillaries, lung vessels, pleura, and ventilatory muscles. Acute respiratory events may also precipitate disease-specific extrapulmonary organ involvement such as aspiration pneumonia and lead to digestive tract involvement and heart-related respiratory events. Finally, antirheumatic drug-related acute respiratory toxicity as well as lung infections related to the rheumatic disease and/or to immunosuppression complete the spectrum of acute respiratory events. Overall, in CTDs the lungs significantly contribute to morbidity and mortality, since they constitute a common site of disease involvement; a major site of infections related to the ‘mater' disease; a major site of drug-related toxicity, and a common site of treatment-related infectious complications. The extreme spectrum of the abovementioned events, as well as the ‘vicious' coexistence of most of the aforementioned manifestations, requires skills, specific diagnostic and therapeutic means, and most of all a multidisciplinary approach of adequately prepared and expert scientists. Avoiding lung disease might represent a major concern for future advancements in the treatment of autoimmune disorders.

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Section: Dah Syndromesmentioning

confidence: 99%

Acute Respiratory Events in Connective Tissue Disorders

Papiris¹,

Manali²,

Kolilekas³

et al. 2016

Respiration

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“…Alveolar hemorrhage is a rare, life-threatening complication which occurs in approximately 0.5–3.7% of nonpregnant SLE patients [9, 10] and has also been reported during pregnancy in a limited number of case reports and case series [11–13]. This is typically associated with active class III or IV lupus nephritis and increased disease activity.…”

Section: Discussionmentioning

confidence: 99%

Severe Maternal Morbidity Associated with Systemic Lupus Erythematosus Flare in the Second Trimester of Pregnancy

Blitz

Fleischer

2018

Case Reports in Obstetrics and Gynecology

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Pregnancy in women with systemic lupus erythematosus (SLE) is associated with an increased risk of adverse maternal and fetal outcomes. Here, we present a case of severe maternal morbidity in a 23-year-old primigravida with SLE and secondary Sjögren's syndrome who experienced a life-threatening multisystem flare at 17 weeks of gestational age. She presented to the emergency department complaining of cough with hemoptysis and shortness of breath. She developed hypoxic respiratory failure and was admitted to the intensive care unit. Bronchoscopy confirmed diffuse alveolar hemorrhage. Physical exam and laboratory evaluation were consistent with an active SLE flare, pancytopenia, and new-onset lupus nephritis. After counseling regarding disease severity, poor prognosis, and recommendation for therapy with cytotoxic agents, she agreed to interruption of pregnancy which was achieved by medical induction. Her course was further complicated by thrombotic microangiopathy and generalized tonic-clonic seizures attributable to posterior reversible encephalopathy syndrome versus neuropsychiatric SLE. This case represents one of the most extreme manifestations of lupus disease activity associated with pregnancy that has been reported in the literature and emphasizes the importance of preconception evaluation and counseling and a multidisciplinary management approach in cases with a complex and evolving clinical course.

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“…Furthermore, the sudden appearance of diffuse pulmonary infiltrates in patients with SLE is a relatively rare eventre presenting a challenging diagnosis. Several pathological events might be responsible for this manifestation, including infection, congestive heart failure with acute pulmonary edema, pulmonary embolism, hemorrhage due to severe coagulopathy, and pneumonitis with or without hemorrhage [2, 5–7]. …”

Section: Discussionmentioning

confidence: 99%

Alveolar hemorrhage as the initial presentation of systemic lupus erythematosus

Holanda¹,

Barreto²,

Araujo³

et al. 2016

Reumatologia

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Alveolar hemorrhage (AH) is a rare syndrome that can often occur in autoimmune diseases, blood clotting disorders, infection or by acute inhalation injury, presenting rapid evolution and high mortality, especially with late diagnosis and treatment. Among the autoimmune diseases, there are reported cases in patients with primary antiphospholipid syndrome (PAPS), vasculitis and systemic lupus erythematosus (SLE). An early diagnosis is an essential tool in the successful management of this complication, requiring aggressive treatment based on vigorous immunosuppression and broad-spectrum antibiotic. We describe here a case of alveolar hemorrhage associated with glomerulonephritis as the open presentation in a patient with SLE.

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Alveolar hemorrhage in systemic lupus erythematosus: a cohort review

Cited by 64 publications

References 25 publications

Acute Respiratory Events in Connective Tissue Disorders

Acute Respiratory Events in Connective Tissue Disorders

Severe Maternal Morbidity Associated with Systemic Lupus Erythematosus Flare in the Second Trimester of Pregnancy

Alveolar hemorrhage as the initial presentation of systemic lupus erythematosus

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