Chest
Clinical InvestigationsDIFFUSE LUNG DISEASEAlveolar Hemorrhage in Systemic Lupus Erythematosus: Presentation and Management
Section snippets
Materials and Methods
We performed a retrospective review of the medical records of patients meeting the preliminary inclusion criteria. Cases of AHconfirmed by demonstration of a bloody return on BAL withhemosiderin-containing macrophages were selected.
It was predefined that patients would be excluded if they haddrug-induced lupus, coagulopathies (international normalized ratio>3.5 s in patients receiving warfarin, severe chronic liverdisease, end-stage renal disease receiving dialysis), pulmonary edemafrom
Results
Between January 1993 and July 1998, seven patients with 11episodes of pulmonary hemorrhage met criteria for inclusion. These 7patients represented 1.0% (7 of 663) of patients with SLE admitted orreferred to the Cleveland Clinic Foundation with a listed diagnosis of SLE. Eight of 11 episodes occurred in the spring (n = 4) and summer(n = 4). There was no statistically significant pattern of seasonaloccurrence.
Discussion
Tables 2, 3summarize the patient characteristics, clinical presentations, treatments, and outcomes from this series, compared with data frompreviously published reports. A central theme in the previouslypublished literature is the high mortality rate seen with AH from SLE. Our observed patient survival of 100% is in marked contrast to mostseries, but reinforces the findings by Schwab et al,8 thatAH is a survivable complication of SLE.
Similar to most reports, most of our patients were young
Conclusion
AH is a serious manifestation of pulmonary SLE that may occurearly or late in disease evolution. It is survivable, despite itsfrequently dramatic presentation. Extrapulmonary disease may be minimaland may be masked in patients who are already receivingimmunosuppression for other symptoms of SLE. Predictors of patients atrisk for this complication are unclear at this time. The capacity of AHto occur and recur despite ongoing immunosuppressive therapy isemphasized in this series. AH may present
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