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Management of massive diffuse alveolar hemorrhage in a child with systemic lupus erythematosus

Dai Kimura1, Samir Shah2, Mario Briceno-Medina3

  • 1Division of Pediatric Critical Care Medicine, Department of Pediatrics, Le Bonheur Children's Hospital/University of Tennessee Health Science Center, 50 N. Dunlap St, TN Memphis, 38103 USA.

Journal of Intensive Care
|May 24, 2016
PubMed

Insights

Diffuse alveolar hemorrhage (DAH) in systemic lupus erythematosus (SLE) is rare and dangerous. This case shows successful management of severe DAH in a young SLE patient using ECMO, surgery, and intensive medical therapy.

Area of Science:

  • Rheumatology
  • Pulmonology
  • Critical Care Medicine

Background:

  • Systemic lupus erythematosus (SLE) can manifest with severe pulmonary complications.
  • Diffuse alveolar hemorrhage (DAH) is a rare but life-threatening SLE manifestation.

Observation:

  • A 14-year-old female with SLE presented with hypoxia and shock.
  • The patient experienced severe alveolar hemorrhage.

Findings:

  • Successful management involved extracorporeal membrane oxygenation (ECMO).
  • Emergent pulmonary lobectomy was performed.
  • Treatment included high-dose methylprednisolone, cyclophosphamide, IV immunoglobulin, and plasmapheresis.

Implications:

  • This case highlights a multidisciplinary approach for managing severe SLE-related DAH.
  • Aggressive treatment strategies, including ECMO and surgery, can be life-saving.
  • Early recognition and intervention are crucial for favorable outcomes in SLE-DAH.

Keywords:
Diffuse alveolar hemorrhage (DAH)Extracorporeal membrane oxygenation (ECMO)HemoptysisLobectomyPlasmapheresisSystemic lupus erythematosus (SLE)

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