Analysis of systemic lupus erythematosus-related interstitial pneumonia: a retrospective multicentre study

Abstract

Thoracic diseases in patients with systemic lupus erythematosus (SLE), especially interstitial pneumonia (SLE-IP), are rare and have been poorly studied. The aims of this multicentre study were to evaluate SLE-IP and elucidate its clinical characteristics and prognosis. Fifty-five patients with SLE-IP who had attended the respiratory departments of participating hospitals were retrospectively evaluated in this multicentre study. Clinical information, high-resolution computed tomography (HRCT), and surgical lung biopsy/autopsy specimens were analysed by respiratory physicians, pulmonary radiologists, and pulmonary pathologists. IP patterns on HRCT and lung specimens were classified based on the international classification statement/guideline for idiopathic interstitial pneumonias. The most frequent form of SLE-IP at diagnosis was chronic IP (63.6%), followed by subacute (20.0%), and acute IP (12.7%). Radiologically, the most common HRCT pattern was “Unclassifiable” (54%). Histologically, “Unclassifiable” was the most frequently found (41.7%) among 12 patients with histologically proven IP. Interestingly, accompanying airway diseases were present in nine of these patients (75%). In multivariate analysis, current smoking (hazard ratio [HR] 6.105, p = 0.027), thrombocytopenia (HR 7.676, p = 0.010), anti-double-strand DNA titre (HR 0.956, p = 0.027), and nonspecific interstitial pneumonia (NSIP) + organizing pneumonia (OP) pattern on HRCT (vs. NSIP, HR 0.089, p = 0.023) were significant prognostic factors. In conclusion, chronic IP was the most frequent form of IP in patients with SLE-IP, and “Unclassifiable” was the commonest pattern radiologically and histologically.

Longitudinal lung involvement of systemic lupus erythematosus‐related vasculitis and alveolar proteinosis‐like reaction

“…Furthermore, in terms of parenchymal lung lesion such as interstitial pneumonia, lung focal involvement is scarce in patients with SLE. We reported 62 patients with SLE with thoracic diseases who visited respiratory departments [5]. In that report, lung focal consolidation on HRCT similar to this case was not found except for infection.…”

“…In that report, lung focal consolidation on HRCT similar to this case was not found except for infection. Furthermore, neither SLErelated vasculitis nor PAP-like lesion was found [5]. As for vasculitis in SLE, Ramos-Casals et al studied 670 patients with SLE and vasculitis was identified in 76 (11%) patients [3].…”

Patients with Interstitial Lung Disease Secondary to Autoimmune Diseases: How to Recognize Them?

“…The latter pattern is a common feature of IIM-ILD [124][125][126][127][128][129][130][131]. Figure 3 shows an indicative proportion of the frequency of each HRCT pattern for each rheumatic disease [47,[124][125][126][127][128][129][130][131]. The proportions reported can widely vary in the studies, depending from the criteria used for the patients' enrollment and/or HRCT classification, as well as the stage of the disease at the time of the study.…”

A Female With Systemic Lupus Erythematosus and Streptococcal Pneumonia Treated With Intravenous Immunoglobulins (Ivig)

“…Recurrent chest infections may be a late clinical manifestation of this autoimmune disease. Garcia-Guevara and collaborators (2018) reported that pneumonia remains the leading cause of mortality in patients with systemic lupus erythematosus (SLE), and the most common bacteria isolated are S. aureus, but other genera of bacteria have been cited [10][11].…”

“…IVIG is a product prepared from fractioning pools of thousands of plasma donations and collected at blood transfusion services [6][7][8][9]. Other proteins, such as traces of IgM and IgA [10], cytokines, and immunomodulating peptides [11], can be in the preparation along with purified IgG. This paper described a compelling case of a young female with pneumonia and systemic manifestations of SLE and treated with IVIG produced at "Serum and Blood-Derivative Products Company "Adalberto Pesant".…”