Introduction: SLE is a multisystem autoimmune disease with variable clinical presentation. DAH is a rare but catastrophic manifestation of SLE with high mortality, requiring early, intensive therapy. Case Presentation: A 31-year-old female presented with low-grade fever and joint pains for six weeks associated with alopecia, anorexia, and weight loss. She had pale and had cervical lymphadenopathy, moderate hepatomegaly, and splenomegaly. Hb level was 9.2mg/dL, with a platelet count of 144 × 103/µL. The ESR was 65mm/hour, and the CRP level was 36 mg/L with a UPCR of 332mg/g. She had low C3, C4 levels, positive ANA, and dsDNA titer. A renal biopsy revealed class 3 lupus nephritis. Twenty days after, she was readmitted with acute onset of pleuritic chest pain, cough, and dyspnea, where she was hemodynamically unstable with SpO2 of 85% on air. The Hb level was 8.6 g/dL with a platelet count of 106 × 103/µL. Her condition deteriorated despite standard medical care, where the Hb level and SpO2 dropped to 5.6 d/dL and 65%, respectively, even after blood transfusions, intubation, and artificial ventilation. The chest X-ray revealed bilateral large whitish hazy shadows, and the HRCT scan revealed diffuse bilateral pulmonary hemorrhages. Then she was transferred to the ICU, and there she was started with broad-spectrum antibiotics, methylprednisolone, and plasmapheresis. However, after one week of ICU stay, her renal functions worsened, and she was initiated on CRRT. However, despite all the resuscitation efforts, she succumbed following a cardiac arrest. Conclusion: DAH is a rare catastrophic complication of SLE, which usually presents in patients with an established diagnosis of SLE, even on medical therapy. The diagnosis of DAH is problematic because it mimics a severe pulmonary infection. Early detection and aggressive management are warranted to improve affected patients' outcomes and quality of life.
| Published in | International Journal of Immunology (Volume 9, Issue 4) |
| DOI | 10.11648/j.iji.20210904.11 |
| Page(s) | 68-72 |
| Creative Commons |
This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited. |
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Copyright © The Author(s), 2021. Published by Science Publishing Group |
Systemic Lupus Erythematosus, Diffuse Alveolar Hemorrhage, Pulmonary Hemorrhage
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APA Style
Parackrama Karunathilake, Ruwanthi Jayasinghe, Thilak Jayalath, Shamali Abeyagunawardena, Udaya Ralapanawa. (2021). A Fatal Case of Systemic Lupus Erythematosus Complicated with Diffuse Alveolar Hemorrhage. International Journal of Immunology, 9(4), 68-72. https://doi.org/10.11648/j.iji.20210904.11
ACS Style
Parackrama Karunathilake; Ruwanthi Jayasinghe; Thilak Jayalath; Shamali Abeyagunawardena; Udaya Ralapanawa. A Fatal Case of Systemic Lupus Erythematosus Complicated with Diffuse Alveolar Hemorrhage. Int. J. Immunol. 2021, 9(4), 68-72. doi: 10.11648/j.iji.20210904.11
AMA Style
Parackrama Karunathilake, Ruwanthi Jayasinghe, Thilak Jayalath, Shamali Abeyagunawardena, Udaya Ralapanawa. A Fatal Case of Systemic Lupus Erythematosus Complicated with Diffuse Alveolar Hemorrhage. Int J Immunol. 2021;9(4):68-72. doi: 10.11648/j.iji.20210904.11
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author = {Parackrama Karunathilake and Ruwanthi Jayasinghe and Thilak Jayalath and Shamali Abeyagunawardena and Udaya Ralapanawa},
title = {A Fatal Case of Systemic Lupus Erythematosus Complicated with Diffuse Alveolar Hemorrhage},
journal = {International Journal of Immunology},
volume = {9},
number = {4},
pages = {68-72},
doi = {10.11648/j.iji.20210904.11},
url = {https://doi.org/10.11648/j.iji.20210904.11},
eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.iji.20210904.11},
abstract = {Introduction: SLE is a multisystem autoimmune disease with variable clinical presentation. DAH is a rare but catastrophic manifestation of SLE with high mortality, requiring early, intensive therapy. Case Presentation: A 31-year-old female presented with low-grade fever and joint pains for six weeks associated with alopecia, anorexia, and weight loss. She had pale and had cervical lymphadenopathy, moderate hepatomegaly, and splenomegaly. Hb level was 9.2mg/dL, with a platelet count of 144 × 103/µL. The ESR was 65mm/hour, and the CRP level was 36 mg/L with a UPCR of 332mg/g. She had low C3, C4 levels, positive ANA, and dsDNA titer. A renal biopsy revealed class 3 lupus nephritis. Twenty days after, she was readmitted with acute onset of pleuritic chest pain, cough, and dyspnea, where she was hemodynamically unstable with SpO2 of 85% on air. The Hb level was 8.6 g/dL with a platelet count of 106 × 103/µL. Her condition deteriorated despite standard medical care, where the Hb level and SpO2 dropped to 5.6 d/dL and 65%, respectively, even after blood transfusions, intubation, and artificial ventilation. The chest X-ray revealed bilateral large whitish hazy shadows, and the HRCT scan revealed diffuse bilateral pulmonary hemorrhages. Then she was transferred to the ICU, and there she was started with broad-spectrum antibiotics, methylprednisolone, and plasmapheresis. However, after one week of ICU stay, her renal functions worsened, and she was initiated on CRRT. However, despite all the resuscitation efforts, she succumbed following a cardiac arrest. Conclusion: DAH is a rare catastrophic complication of SLE, which usually presents in patients with an established diagnosis of SLE, even on medical therapy. The diagnosis of DAH is problematic because it mimics a severe pulmonary infection. Early detection and aggressive management are warranted to improve affected patients' outcomes and quality of life.},
year = {2021}
}
TY - JOUR T1 - A Fatal Case of Systemic Lupus Erythematosus Complicated with Diffuse Alveolar Hemorrhage AU - Parackrama Karunathilake AU - Ruwanthi Jayasinghe AU - Thilak Jayalath AU - Shamali Abeyagunawardena AU - Udaya Ralapanawa Y1 - 2021/10/28 PY - 2021 N1 - https://doi.org/10.11648/j.iji.20210904.11 DO - 10.11648/j.iji.20210904.11 T2 - International Journal of Immunology JF - International Journal of Immunology JO - International Journal of Immunology SP - 68 EP - 72 PB - Science Publishing Group SN - 2329-1753 UR - https://doi.org/10.11648/j.iji.20210904.11 AB - Introduction: SLE is a multisystem autoimmune disease with variable clinical presentation. DAH is a rare but catastrophic manifestation of SLE with high mortality, requiring early, intensive therapy. Case Presentation: A 31-year-old female presented with low-grade fever and joint pains for six weeks associated with alopecia, anorexia, and weight loss. She had pale and had cervical lymphadenopathy, moderate hepatomegaly, and splenomegaly. Hb level was 9.2mg/dL, with a platelet count of 144 × 103/µL. The ESR was 65mm/hour, and the CRP level was 36 mg/L with a UPCR of 332mg/g. She had low C3, C4 levels, positive ANA, and dsDNA titer. A renal biopsy revealed class 3 lupus nephritis. Twenty days after, she was readmitted with acute onset of pleuritic chest pain, cough, and dyspnea, where she was hemodynamically unstable with SpO2 of 85% on air. The Hb level was 8.6 g/dL with a platelet count of 106 × 103/µL. Her condition deteriorated despite standard medical care, where the Hb level and SpO2 dropped to 5.6 d/dL and 65%, respectively, even after blood transfusions, intubation, and artificial ventilation. The chest X-ray revealed bilateral large whitish hazy shadows, and the HRCT scan revealed diffuse bilateral pulmonary hemorrhages. Then she was transferred to the ICU, and there she was started with broad-spectrum antibiotics, methylprednisolone, and plasmapheresis. However, after one week of ICU stay, her renal functions worsened, and she was initiated on CRRT. However, despite all the resuscitation efforts, she succumbed following a cardiac arrest. Conclusion: DAH is a rare catastrophic complication of SLE, which usually presents in patients with an established diagnosis of SLE, even on medical therapy. The diagnosis of DAH is problematic because it mimics a severe pulmonary infection. Early detection and aggressive management are warranted to improve affected patients' outcomes and quality of life. VL - 9 IS - 4 ER -
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