Citation Information :
Juneja D, Singh O, Mukherji JD, Grover R, Sharma T. Life-threatening Diffuse Alveolar Hemorrhage in a Patient with Systemic Lupus Erythematosus and Antiphospholipid Syndrome. 2023; 2 (6):168-171.
Introduction: Autoimmune diseases may have myriad presentations and may sometimes present with life-threatening systemic complications. Here, we present a case who presented with massive hemoptysis and was diagnosed to have systemic lupus erythematosus (SLE) with secondary antiphospholipid syndrome (APS) and diffuse alveolar hemorrhage (DAH).
Case description: A 45-year-old female, a known case of hypertension and seizure disorder, presented with a 1-day history of breathlessness and hemoptysis. She required intubation and invasive mechanical ventilation in view of massive hemoptysis and high oxygen requirement. Subsequent investigations confirmed the diagnosis of SLE with secondary APS and DAH, and she was treated with pulse dose corticosteroids and rituximab with a favorable outcome.
Conclusion: SLE and APS may rarely present with bleeding complications like DAH. Hence, a high index of suspicion must be kept as early therapy with immunosuppressants like high-dose corticosteroids and rituximab may lead to good clinical outcomes.
Petri M, Orbai AM, Alarcón GS, et al. Derivation and validation of the systemic lupus international collaborating clinics classification criteria for systemic lupus erythematosus. Arthritis Rheum 2012;64(8):2677–2686. DOI: 10.1002/art.34473
Al-Adhoubi NK, Bystrom J. Systemic lupus erythematosus and diffuse alveolar hemorrhage, etiology and novel treatment strategies. Lupus 2020;29(4):355–363. DOI: 10.1177/0961203320903798
Torre O, Harari S. Pleural and pulmonary involvement in systemic lupus erythematosus. Presse Med 2011;40(1Pt 2):e19–e29. DOI: 10.1016/j.lpm.2010.11.004
Fidler L, Keen KJ, Touma Z, et al. Impact of pulmonary disease on patient-reported outcomes and patient-performed functional testing in systemic lupus erythematosus. Lupus 2016;25(9):1004–1011. DOI: 10.1177/0961203316630818
Levine JS, Branch DW, Rauch J. The antiphospholipid syndrome. N Engl J Med 2002;346(10):752–763. DOI: 10.1056/NEJMra002974
Tektonidou MG, Laskari K, Panagiotakos DB, et al. Risk factors for thrombosis and primary thrombosis prevention in patients with systemic lupus erythematosus with or without antiphospholipid antibodies. Arthritis Rheum 2009;61(1):29–36. DOI: 10.1002/art.24232
Cervera R, Piette JC, Font J, et al. Euro-phospholipid project group antiphospholipid syndrome: clinical and immunologic manifestations and patterns of disease expression in a cohort of 1,000 patients. Arthritis Rheum 2002;46(4):1019–1027. DOI: 10.1002/art.10187
Wahl DG, Bounameaux H, de Moerloose P, et al. Prophylactic antithrombotic therapy for patients with systemic lupus erythematosus with or without antiphospholipid antibodies: do the benefits outweigh the risks? A decision analysis. Arch Intern Med 2000;160(13):2042–2048. DOI: 10.1001/archinte.160.13.2042
Aakjær S, Bendstrup E, Ivarsen P, et al. Continuous rituximab treatment for recurrent diffuse alveolar hemorrhage in a patient with systemic lupus erythematosus and antiphosholipid syndrome. Respir Med Case Rep 2017;22:263–265. DOI: 10.1016/j.rmcr.2017.09.012
Jiang M, Chen R, Zhao L, et al. Risk factors for mortality of diffuse alveolar hemorrhage in systemic lupus erythematosus: a systematic review and meta-analysis. Arthritis Res Ther 2021;23(1):57. DOI: 10.1186/s13075-021-02435-9
