Pulmonary hemorrhage in systemic lupus erythematosus

Badsha, Humeira; Teh, Cheng Lay; Kong, Kok Ooi; Lian, Tsui Yee; Chng, Hiok Hee

doi:10.1016/j.semarthrit.2003.09.006

Cited by 115 publications

(124 citation statements)

References 20 publications

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“…Immunosuppressive therapies including high-dose steroids and cyclophosphamide (CYC), which may decrease the high mortality, should be started immediately after diagnosis. Plasmapheresis may be useful for patients who are not responsive to the above regimens [8]. In recent years, SLE-associated DAH treated successfully with rituximab without CYC administration has been reported in some cases, but lacks larger-scale clinical studies [9][10][11].…”

Section: Introductionmentioning

confidence: 99%

Allogeneic transplantation of umbilical cord-derived mesenchymal stem cells for diffuse alveolar hemorrhage in systemic lupus erythematosus

Shi

Wang

et al. 2012

Clin Rheumatol

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Umbilical cord-derived mesenchymal stem cell transplantation (UC-MSCT) has been proved to be effective in the treatment of systemic lupus erythematosus (SLE), based on animal experiments and clinical trials. Diffuse alveolar hemorrhage (DAH) is a rare complication of SLE with a high mortality usually over 50%. This study aimed to assess the efficacy of UC-MSCT in the treatment of SLE-associated DAH. Four SLE patients complicated with DAH, who underwent UC-MSCT, were included. Clinical changes before and after transplantation were assessed by measurements of hemoglobin, platelet level, oxygen saturation, and serological factors. High-resolution CT (HRCT) scans of the chest were performed to evaluate pulmonary manifestation. All the four patients showed dramatic improvements of their clinical manifestations. Hemoglobin was elevated after UC-MSCT and was sustained at a normal level 6 months after UC-MSCT in the four patients. Platelet level was upregulated in two patients who had thrombocytopenia at baseline. Oxygen saturation appeared to be normal at 1 month after UC-MSCT, and this result was confirmed by the HRCT scan of the chest. Serum albumin elevated to 3.5 g/dl 6 months after transplantation. Our findings suggest that UC-MSCT results in amelioration of oxygen saturation as well as hematological and serologic changes, which revealed that UC-MSCT could be applied as a salvage strategy for DAH patients.

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Section: Introductionmentioning

confidence: 99%

Allogeneic transplantation of umbilical cord-derived mesenchymal stem cells for diffuse alveolar hemorrhage in systemic lupus erythematosus

Shi

Wang

et al. 2012

Clin Rheumatol

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“…The most common pulmonary manifestation is pleuritis, but the most devastating pulmonary complication is pulmonary hemorrhage with a mortality rate reported to be as high as 70-90% [4,5]. In most cases DAH develops in patients with established SLE, often in the setting of active other organ involvement, including nephritis or neuropsychiatric lupus [1,4,5]. In the current case, the patient presented with DAH as the first clinical manifestation of SLE without lupus nephritis or other organ involvement.…”

Section: Discussionmentioning

confidence: 99%

Successful Early Rituximab Treatment in a Case of Systemic Lupus Erythematosus with Potentially Fatal Diffuse Alveolar Hemorrhage

Chang

Seo

et al. 2014

Respiration

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Diffuse alveolar hemorrhage (DAH) is a rare but devastating complication of systemic lupus erythematosus (SLE) with a high early mortality rate. DAH seldom occurs without active organ involvement. Recently, rituximab (RTX), a B cell-targeted therapy, has been reported to be effective for life-threatening autoimmune diseases. We describe a SLE patient who presented with acute respiratory failure due to DAH without other active organ involvement. This condition was dramatically improved with RTX without cyclophosphamide.

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“…DAH is a rare but one of the most dreadful manifestation of SLE. It has a prevalence that ranges from 0.5 to 5.7% with a female to male ratio of approximately 6 to 1 [23][24][25][26][27][28][29][30][31]. DAH is the first manifestation of SLE in 11-20% of the cases.…”

Section: Acute Pulmonary Diseasesmentioning

confidence: 99%

“…Anemia is usually due to acute blood loss, whereas the extent of hemoptysis is variable and not directly related to the severity of hemorrhage as blood in the acini may not communicate with proximal airways, even in severe cases. Mucocutaneous manifestations, central nervous system involvement, hematologic abnormalities, elevated anti-dsDNA antibodies and low C3 and C4 complements are often observed in these patients [23][24][25][26][27][28][29][30][31]. Arterial hypoxemia is common and more than 50% of the patients will need mechanical ventilation.…”

Section: Acute Pulmonary Diseasesmentioning

confidence: 99%