Alveolar haemorrhage and lymphocytic interstitial pneumonitis in SLE

Case contributed by Dr Jan Frank Gerstenmaier

Presentation

This patient with known SLE presents with haemoptysis and shortness of breath.

Patient Data

Age: 70
Gender: Female

There is a patchy airspace infiltrate in the left upper zone.

Numerous intrapulmonary cysts, the largest measuring 3 cm in the left lower lobe. Left upper lobe ground glass opacity occupies most of the apical segment. Regional cysts demonstrate air-fluid levels. Several pulmonary nodules: 17 x 14mm right lower lobe anterior segment (image 23 se 6); this nodule is of fluid attenuation 7 x 7mm right upper lobe (image 14 se 6) 6 x 6mm right apex (image 9 se 6) 7 x 6mm right lower lobe anterior basal segment (image 25 se 6) No thoracic lymphadenopathy. Moderately severe cardiomegaly.

Dense pleural calcification, right medial basal region. Mild central pulmonary arterial dilation. 2 low attenuation hepatic lesions: 14mm segment 2 anterior subcapsular (image 46 se 4) 8mm segment 7 posterior subcapsular (image 43 se 4)

CONCLUSION:

Appearances suggest lymphoid interstitial pneumonia. The left upper lobe GGO has a relatively wide DDx including haemorrhage and less likely aspiration or infection. Malignancy is considered unlikely.

Pulmonary hypertension.

No CT evidence of arterial dissection or pulmonary embolus.

X-ray

The patient deteriorated and was intubated. Haemoptysis became massive.

Extensive airspace opacification L>R compatible with alveolar haemorrhage. ETT adequate.

The patient deteriorated; the haemoptysis became massive and the patient died shortly after ICU admission.

Case Discussion

A post-mortem was carried out and confirmed massive alveolar haemorrhage, a recognised complication of systemic lupus erythematosus.

The lung cysts are in keeping with lymphocytic interstitial pneumonitis, of which SLE is one of the associations.

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Case information

rID: 28582
Case created: 1st Apr 2014
Last edited: 16th Jul 2017
System: Chest
Inclusion in quiz mode: Included

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