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Poster Walks: Poster Walk 7: Infection/Lung Cancer |

P226 Systemic lupus erythematous with apparently acute onset with respiratory failure caused by mixed infection (klebsiella and pneumocystis jiroveci)

G. Jimborean; E.S. Ianosi; P. Postolache; O.V. Jimborean
Author and Funding Information

1Pulmonology, University of Medicine and Pharmacy Tg. Mures, Tirgu Mures

2Pulmonary Rehabilitation, University of Medicine and Pharmacy Iasi, Iasi

3Second Clinic of Surgery Tirgu Mures, County Emergency Clinic Hospital, Tirgu Mures, Romania


Copyright 2017, American College of Chest Physicians and Swiss Respiratory Society SGP. All Rights Reserved.


Chest. 2017;151(5_S):A125. doi:10.1016/j.chest.2017.04.132
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Introduction: Systemic lupus erythematous (SLE) is an autoimmune disease with variable presentation and onset. Pleuropulmonary involvement is common and sometime wears an acute onset with infections overlay favored by the characteristic disimmunity.

Methods: Case report of a SLE with apparently acute clinical onset with respiratory failure caused by a mixed pulmonary infection.

Results: A 50 year-old male patient with a history of chronic glomerulonephritis (cause unknown), hypertension and obesity was hospitalized in Pulmonology Clinic for rest dyspnea, productive cough, wheezing, facial and legs edema, malar rush, fever, oliguria, tachycardia. CT highlights acute lung injury with multiple “ground glass” areas, bilateral pleural effusion, and pericarditis. Echocardiography: pericarditis, dilated right ventricle and pulmonary hypertension. Spirometry: severe mixed ventilatory dysfunction and hypoxemia. Laboratory investigation: anemia (Hb-7.7g%; Hct-24%), leukocytosis, low blood proteins (4.6g%), fibrinogen 540mg%, complement C3 (39mg%), dyslipidemia, hepatocytolysis, hyperuricemia, high blood urea. Initially, seric immunology was negative (antinuclear antibody Ab-ANA, rheumatoid factor, anti-cardiolipin Ab, antiglomerular basement membrane Ab, anti-HIV Ab). Urine: proteinuria 2,19g/24 hours, 50 erythrocytes/μl. The patient refused kidney or other biopsy. Bronchoscopy allowed bronchoalveolar lavage (BAL) and found ANA Ab positive, presence of Candida species, Gram negative bacteria, cysts of Pneumocystis jiroveci. The diagnostic of the SLE with apparently acute onset and Pneumocystis pneumonia was based on the presence of bilateral infiltrates, pleural effusion, pericarditis, anemia, and malar rush, positive ANA in LBA, nephropathy with impure nephrotic/nephritic syndrome, decreased blood complement C3. We started corticoids, antibiotics, oxygen therapy, bronchodilators, anti-fungal and anti-parasitic drugs, statins, antihypertensive and anticoagulants. The evolution was rapidly favorable.

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