Diffuse Alveolar Hemorrhage as a Life-Threatening Complication of Systemic Lupus Erythematosus: A Case Report

Diffuse alveolar hemorrhage (DAH) is a rare but severe pulmonary complication in systemic lupus erythematosus (SLE), characterized by alveolar bleeding leading to respiratory distress, hypoxemia, and often hemoptysis. Rapid diagnosis and aggressive immunosuppressive therapy are crucial for survival. A 55-year-old woman with a five-year history of SLE presented with acute dyspnea, hemoptysis, pleuritic chest pain, fatigue, and low-grade fever. On examination, she had bilateral crackles on auscultation, hypoxemia, tachycardia, and mild pitting edema. Laboratory tests revealed anemia, elevated anti-double-stranded DNA (anti-dsDNA) titers, and low complement levels. Imaging studies showed bilateral patchy infiltrates on chest X-ray and ground-glass opacities on high-resolution CT (HRCT), suggesting DAH. Differential diagnoses considered included lupus pneumonitis, infection, and pulmonary embolism, but DAH was strongly suspected based on the patient's clinical presentation, lab, and imaging findings. Treatment with high-dose intravenous methylprednisolone and cyclophosphamide was initiated, leading to stabilization of respiratory symptoms and gradual improvement. The patient was discharged on oral corticosteroids and hydroxychloroquine, with significant clinical improvement observed at one-month follow-up. DAH in SLE is a medical emergency that requires a multidisciplinary approach and rapid therapeutic intervention. This case underscores the potential for favorable outcomes when DAH is recognized and managed promptly, though further research is needed to refine long-term treatment strategies for these high-risk patients.