Pulmonary Hemorrhage as the Initial Manifestation in Systemic Lupus Erythematosus with Active Nephritis: Case Report

Abstract

ulmonary hemorrhage (PH) is a rare and frequently fatal condition with mortality rates as high as 50-90%.1-3. The occurrence of massive PH as the initial and sole clinical manifestation of systemic lupus erythematosus (SLE) with active nephritis has rarely been reported.4,5 Treatment of PH in SLE remains controversial because no randomized trials are available. The experience from a number of case series suggests that high dosage of pulse corticosteroids with plasmapheresis, cyclophosphamide (CP) or both improves survival.1,6. We report a 50-year-old male with PH as the initial clinical manifestation of SLE, who had clinical response to early aggressive pulse methylprednisolone and CP therapy but whose PH relapsed later. Case ReportA AB BS ST TR RA AC CT T Pulmonary hemorrhage is the most devastating pulmonary complication of systemic lupus erythematosus. It has rarely been reported to occur as the initial presentation in lupus patients.We report a 50-year-old male who presented with pulmonary hemorrhage and nephritis as the initial manifestation of systemic lupus erythematosus. He presented with dyspnea, hemoptysis and pretibial edema. He responded to early intravenous pulse methylprednisolone therapy and cyclophosphamide therapy, but his pulmonary hemorrhage relapsed 20 days later. He was given intravenous methylprednisolone, intravenous cyclophosphamide and 5 sessions of plasmapheresis, resulting in temporal stabilization of his condition. Pulmonary hemorrhage in this connective tissue disease is an uncommon but serious complication with high mortality rates in spite of intensive treatment.K Ke ey y W Wo or rd ds s: : Systemic lupus erythematosus; lung diseases; lupus nephritis Ö ÖZ ZE ET T Pulmoner hemoraji sistemik lupus eritematozusun en yıkıcı pulmoner komplikasyonudur. Lupus hastalarında ilk bulgu olarak pulmoner hemorajinin görülmesi nadir olarak bildirilmiştir. Biz, sistemik lupus eritematozusun ilk bulgusu olarak pulmoner hemoraji ve nefrit ile gelen 50 yaşında bir erkek hastayı sunduk. Hasta, dispne, hemoptizi ve pretibial ödemle başvurdu. Erken intravenöz pals metilprednizolon tedavisine ve siklofosfamid tedavisine yanıt verdi fakat pulmoner hemorajisi 20 gün sonra tekrarladı. İntravenöz metilprednizolon, intravenöz siklofosfamid ve 5 seans plazmaferez verildi, durumunda geçici bir düzelme gözlendi. Bu bağ doku hastalığında pulmoner hemoraji yoğun tedaviye rağmen yüksek mortalite hızı olan, sık görülmeyen fakat ciddi bir komplikasyondur.A An na ah ht ta ar r K Ke el li im me el le er r: : Sistemik lupus eritematozus; akciğer hastalıkları; lupus nefriti T Tu ur rk ki iy ye e K Kl li in ni ik kl le er ri i J J M Me ed d S Sc ci i 2 20 01 12 2; ;3 32 2( (4 4)