Aim: To describe our experience with alveolar
hemorrhage (AH) in systemic lupus erythematosus (SLE).
Methods: Review of medical records and pertinent medical
literature using MEDLINE and reference lists from retrieved
Patients: Seven patients with SLE
admitted with episodes of AH (n = 11).
patients were female, and one was male. Mean age at the time of 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
patients. Six patients were already receiving treatment for SLE at the
time of AH. All patients presented with dyspnea and new pulmonary
infiltrates. Hemoptysis occurred in only 54%. All patients had BAL
within 48 h of presentation. Temperature ≥39°C
(102.2°F) accompanied 82% of episodes. Glomerulonephritis was
the most common nonpulmonary SLE manifestation (74%). Treatment with
empiric IV antibiotics was initiated in 10 episodes. Initial treatment
included high-dose corticosteroids (prednisone, 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]).
Plasmapheresis (three to four sessions) was added in five episodes for
persistent AH. All patients survived.
may mimic pneumonia. Hemoptysis may not be evident. Infection must be
aggressively excluded, especially since many patients with AH are
already receiving immunosuppressive therapy. AH frequently
recurs despite ongoing immunosuppression. Although high mortality rates
have been reported with AH in SLE, we observed 100%