Li Xue, Chen Yuxin, Zhang Jianyu, Li Ting, Chen Jian, Lu Yu, Yang Liu
Department of Rheumatology and Immunology, The Third Affiliated Hospital of 117980Guangzhou Medical University, Guangzhou, China.
Lupus. 2023 Jan;32(1):142-148. doi: 10.1177/09612033221136971. Epub 2022 Nov 16.
Systemic lupus erythematosus (SLE) is an autoimmune disease based on the pathology of small-vessel inflammation, which can affect multiple organs. Diffuse alveolar hemorrhage (DAH) is a rare and severe complication of SLE with high mortality, most commonly seen in young women. It often appears along with clinical manifestations of sudden dyspnea, hemoptysis, and rapid onset of hypoxemia, which develops into respiratory failure and even multiple organs damage.
The case of a 28-year-old female who was diagnosed with SLE complicated with DAH is presented here. The patient, who experienced recurring DAH, responded poorly to the common therapy of high-dose glucocorticoid plus cyclophosphamide and plasma exchange. After the treatment was adjusted to a multi-target regimen of glucocorticoid, tacrolimus, mycophenolate mofetil, and belimumab, the symptoms began to improve.
The multi-target regimen may be a new treatment strategy of SLE complicated with DAH.
系统性红斑狼疮（SLE）是一种基于小血管炎症病理的自身免疫性疾病，可累及多个器官。弥漫性肺泡出血（DAH）是SLE罕见且严重的并发症，死亡率高，多见于年轻女性。它常伴有突发呼吸困难、咯血和迅速出现的低氧血症等临床表现，进而发展为呼吸衰竭甚至多器官损害。
本文介绍了一名28岁诊断为SLE合并DAH的女性病例。该患者反复发生DAH，对大剂量糖皮质激素加环磷酰胺及血浆置换的常规治疗反应不佳。在调整为糖皮质激素、他克莫司、霉酚酸酯和贝利尤单抗的多靶点治疗方案后，症状开始改善。
多靶点治疗方案可能是SLE合并DAH的一种新的治疗策略。
