Alveolar Hemorrhage in Systemic Lupus Erythematosus: a Differential Diagnosis of Alveolar Opacities and Anemia
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Introduction: Diffuse alveolar hemorrhage is a rare syndrome of variable severity, which in patients with systemic lupus erythematosus can have a mortality rate of up to 50–90%. It is a true emergency for rheumatology and pulmonology. Intraalveolar bleeding produces, in addition to anemia, alveolar filling that can cause progressive respiratory failure leading to the death of the patient.
Case report: A 35-year-old female with systemic lupus erythematosus and antiphospholipid antibody syndrome was in clinical remission for 5 years; the condition reactivated after pregnancy and miscarriage, requiring resumption of treatment with mycophenolate and azathioprine. She reported 3 months of anemia and mild dyspnea. She was hospitalized with increasing dyspnea and a positive influenza A test, as well as anemia and kidney failure. Imaging studies revealed bilateral consolidations and ground glass syndrome. A diagnostic bronchoscopy was performed, confirming the diagnosis of diffuse alveolar hemorrhage. Treated with pulse glucocorticoids and cyclophosphamide, with evident clinical improvement after the first dose and continued outpatient follow-up.
Conclusion: Diffuse alveolar hemorrhage is a rare and serious disease in systemic lupus erythematosus, which can be unpredictable, considering aggravating factors (such as infections and pregnancy) for the appearance of this complication that is generally acute; but there are chronic cases that should be suspected in patients with anemia and respiratory symptoms of any intensity and new alveolar opacities in imaging studies.
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