Alveolar hemorrhage in systemic lupus erythematosus - Presentation and management

Aim: To describe our experience with alveolar hemorrhage (AH) in systemic l upus erythematosus (SLE), Methods: Review of medical records and pertinent medical literature using M EDLINE and reference lists from retrieved publications. Patients: Seven patients with SLE admitted with episodes of AH (n = 11), Results: Six patients were female, and one was male. Mean age at the time o f AH was 31.1 years. Mean duration of SLE was 4.5 years. AH occurred within 3 weeks of SLE onset in two patients. Recurrent AH was observed in four pa tients. Six patients were already receiving treatment for SLE at the time o f AH. AH patients presented with dyspnea and new pulmonary infiltrates. Hem optysis occurred in only 54%, All patients had BAL within 48 h of presentat ion, Temperature greater than or equal to 39 degreesC (102.2 degreesF) acco mpanied 82% of episodes. Glomerulonephritis was the most common nonpulmonar y SLE manifestation (74%), Treatment with empiric IV antibiotics was initia ted in 10 episodes. Initial treatment included high-dose corticosteroids (p rednisone, 1 to 3 mg/kg/d [n = 2]; or IV methylprednisolone, 1 g/d [n = 9], with or without oral cyclophosphamide, 2 to 3 mg/kg/d [n = 7]). Plasmapher esis (three to four sessions) was added in five episodes for persistent AH. All patients survived, Conclusions: AH may mimic pneumonia, Hemoptysis may not be evident. Infecti on must be aggressively excluded, especially since many patients with AH ar e already receiving immunosuppressive therapy. AH frequently recurs despite ongoing immunosuppression, Although high mortality rates have been reporte d with AH in SLE, we observed 100% survival.