Systemic lupus erythematosus complicated by recurrent pneumothorax: Case report and literature review

Abstract

Pneumothorax is a rare pleuropulmonary manifestation of systemic lupus erythematosus. We encountered a 37-year-old Japanese woman who had systemic lupus erythematosus complicated by recurrent pneumothorax during treatment for recurrent serositis with glucocorticoid therapy. She was admitted for the third episode of lupus peritonitis in December 2005. Intravenous cyclophoshamide and increased dose of oral prednisolone were administered. In early January 2006, hemoptysis was observed and bronchofiberscopy revealed hemorrhage from the left lower lobe. After intravenous methylprednisolone pulse therapy and oral cyclosporine therapy were added, pleurisy and pulmonary hemorrhage improved. On February 22nd, she suddenly developed pneumothorax on the right side, followed by pneumothorax on the left side after 2 days. This pneumothorax on the left side did not improve despite chest tube drainage for over one month. She underwent thoracoscopic partial lobectomy of lower lobe of the left lung, and her symptoms improved. Review of the literature identified 10 case reports of systemic lupus erythematosus complicated by pneumothorax. All of the patients including our case had underlying pulmonary lesions, and 9/11 patients had pleurisy. Besides 10/11 patients received glucocorticoid therapy before the occurrence of pneumothorax. Tissue fragility caused by these factors might contribute to the complication of pneumothorax in patients with systemic lupus erythematosus.

Takayasu arteritis presenting with spontaneous pneumothorax

“…As a result, close monitoring of patients is important because pneumothorax, which occurs in rheumatic diseases, tends to be recurrent. 13 To our knowledge, this is the first description of a patient with spontaneous pneumothorax associated with TA. Although there are other factors that may contribute to the development of pneumothorax, this finding can be considered as part of the wide spectrum of TA.…”

“…9 According to different studies, the incidence of pneumothorax in Wegener's granulomatosis (WG) is between 3 to 5%. 12,13 In certain reported cases of WG, the occurrence of pneumothorax was attributed to the rupture of cavitary lesions and immunosuppressive treatment. 9 In a literature review by Tanaka et al, 13 11 patients with recurrent pneumothorax with SLE were evaluated.…”

“…12,13 In certain reported cases of WG, the occurrence of pneumothorax was attributed to the rupture of cavitary lesions and immunosuppressive treatment. 9 In a literature review by Tanaka et al, 13 11 patients with recurrent pneumothorax with SLE were evaluated. All patients had underlying pulmonary involvement such as interstitial lung disease, pulmonary suppuration, pulmonary hemorrhage, and pulmonary embolism or cyst formation.…”

“…Glucocorticoids have been shown to cause tissue fragility by creating adverse effects on both growth factors, as well as collagen deposition during wound healing. 13 Tissue fragility may be among the factors contributing to pneumothorax. On the other hand, the occurrence of pneumothorax has only been reported in a few cases, and the use of methotrexate and azathioprine, and their potential contribution to pneumothorax is unclear.…”

Spontaneous pneumothorax from cryptococcal pneumonia in systemic sclerosis: a case report

“…SSP in rheumatic diseases have been reported in SSC [2,3], polymyositis [16], mixed connective tissue disease [17], systemic lupus erythematosus [18,19], Wegener's granulomatosis [20,21], relapsing polychondritis [22], ankylosing spondylitis [23], and rheumatoid arthritis [24], particularly in persons with a pre-existing lung disease associated with an underlying connective tissue disease. Spontaneous pneumothorax in SSC has been reported in patients with sub-pleural blebs or lung cysts, which are perhaps due to abnormal collagen in the pulmonary tissue as a result of SSC [2,3,25].…”