Alveolar hemorrhage and possible lymphocytic interstitial pneumonitis in systemic lupus erythematosus
Presentation
History of SLE, presents with hemoptysis and shortness of breath.
Patient Data
Admission CXR
There is a patchy airspace infiltrate in the left upper zone.
CT pulmonary angiography
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, 8mm segment 7 posterior subcapsular
CONCLUSION:
Appearances suggest lymphoid interstitial pneumonia. The left upper lobe GGO has a relatively wide DDx including hemorrhage and less likely aspiration or infection. Malignancy is considered unlikely.
Pulmonary hypertension.
The patient deteriorated &...
The patient deteriorated & was intubated. Hemoptysis became massive.
Extensive airspace opacification L>R compatible with alveolar hemorrhage. ETT adequate.
Case Discussion
The patient deteriorated; the hemoptysis became massive and the patient died shortly after ICU admission. A post-mortem was carried out and confirmed massive alveolar hemorrhage, a recognized complication of systemic lupus erythematosus.
The central lung cysts are suggestive of lymphocytic interstitial pneumonitis, of which SLE is one of the associations.
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