Analysis of systemic lupus erythematosus patients complicated with diffuse alveolar hemorrhage

Objective To analyze the clinical features of systemic lupus erythematosus (SLE) patients complicated with diffuse alveolar hemorrhage (DAH). Methods Clinical data about SLE patients complicated with DAH admitted to the department of rheumatology in our hospital from December 2008 to March 2015 were retrospectively analyzed and its related literatures were reviewed. Results The average age of the 8 SLE patients (2 males and 6 females) complicated with pulmonary hemorrhage included in this study was 34 years. And the mean course of disease was 30 months. All these patients presented with hemoptysis, blood in sputum, hypoxemia, anemia, and new infiltrates on chest CT scan. There were 6 cases with lupus nephritis, 4 with leukopenia or thrombocytopenia, 2 with pulmonary interstitial fibrosis, 1 with pulmonary hypertension and no lupus encephalopathy was found. The mean systemic lupus erythematosus disease activity index (SLEDAI) was 6.6. All patients received steroid pulse therapy together with intravenous immunoglobulin, and 5 of them received immunosuppressor. Three patients died. Conclusion DAH is a rare and catastrophic event in SLE. DAH can occur at any stage of the disease course. Early aggressive management with high-dose steroids may improve the prognosis of DAH.