Lundgren Mia C, Molitor Jerry A, Spilseth Benjamin, Adeyi Oyedele
University of Minnesota Medical School, Minneapolis, MN, USA.
Department of Medicine, Division of Rheumatic and Autoimmune Diseases, University of Minnesota Medical School, Minneapolis, MN, USA.
Case Rep Rheumatol. 2021 Feb 11;2021:6620701. doi: 10.1155/2021/6620701. eCollection 2021.
Systemic lupus erythematosus (SLE) is an autoimmune connective tissue disease, characterized by autoantibody production and immune complex formation, that has the potential to affect virtually any organ. Pleuropulmonary involvement occurs in 50-70% and commonly manifests as pleuritis and pleural effusion. Diffuse alveolar hemorrhage (DAH) is a rare manifestation of SLE. Most cases of DAH occur in young adults with an underlying autoimmune disease such as systemic vasculitis or Goodpasture syndrome. SLE is typically lower on the list of initial differential diagnoses of DAH due to its rarity compared to other etiologies. We present a case of a patient with dyspnea on exertion, dry coughs, lower extremity edema, and intermittent periorbital edema who ultimately succumbed to respiratory failure secondary to DAH in the setting of SLE. The diagnosis of SLE was suspected clinically and confirmed at autopsy due to her rapid clinical deterioration. DAH requires prompt intervention, and management is guided by the underlying disease process. SLE is a potentially treatable disease; therefore, timely diagnosis is important in order to exclude other noninfectious causes of DAH (reviewed in this report) and to initiate appropriate therapy.
系统性红斑狼疮（SLE）是一种自身免疫性结缔组织疾病，其特征为自身抗体产生和免疫复合物形成，几乎有可能影响任何器官。胸膜肺受累发生率为50% - 70%，通常表现为胸膜炎和胸腔积液。弥漫性肺泡出血（DAH）是SLE的一种罕见表现。大多数DAH病例发生在患有潜在自身免疫性疾病（如系统性血管炎或Goodpasture综合征）的年轻成年人中。由于与其他病因相比SLE较为罕见，在DAH的初始鉴别诊断清单中通常排名靠后。我们报告一例患者，该患者有劳力性呼吸困难、干咳、下肢水肿和间歇性眶周水肿，最终在SLE背景下因DAH继发呼吸衰竭而死亡。临床上怀疑该患者患有SLE，因其临床迅速恶化，尸检时得以确诊。DAH需要及时干预，治疗以潜在疾病进程为指导。SLE是一种潜在可治疗的疾病；因此，及时诊断很重要，以便排除DAH的其他非感染性病因（本报告中进行了综述）并启动适当的治疗。
