A case report and literature review of systemic lupus erythematosus with diffuse alveolar hemorrhage

Objective To analyze the clinical characteristics of systemic lupus erythematosus (SLE) with diffuse alveolar hemorrhage (DAH), and to study the efficacy of plasmapheresis combined with hormone in SLE with DA in order to improve the level of diagnosis and treatment of rare cases, and avoid misdiagnosis and delayed treatment. Methods The clinical manifestations of 1 case of SLE with DAH in our hospital were reported, and the clinical effect of plasma exchange combined with corticosteroid for treatment of the patients was observed at the same time. A comprehensive analysis was done on DAH clinical manifestations, treatment and clinical effects of 101 Chinese SLE patients. Results This patient was a 20-year old female, and the main clinical manifestations were fever, bloody sputum, facial erythema, accompanied by vaginal bleeding. The laboratory test showed that the titer of anti-nuclear antibody (ANA) was 1:1000, anti-double stranded DNA (ds-DNA) antibody and anti-Smith antibody were both positive, and hemoglobin was progressively reduced. The chest CT showed two lung fields displayed more spiral shape and spot shape, nodule density increased shadow, and edge was blur. A diagnosis of SLE combined with DAH was made. She was given plasmapheresis combined with glucocorticoid, while giving the human normal immunoglobulin. Thereafter, hemoptysis stopped, facial erythema disappeared, anemia was significantly improved, and now she was given glucocorticoids and got reduction regularly. In our country, 101 cases were reported, and the specific clinical manifestations were described in 83 cases. These patient's ANA was all positive, 58 cases were positive for anti ds-DNA antibody, 67 cases presented with hemoptysis, 61 cases presented with fever, 71 cases presented with renal involvement, hemoglobin decreased in 74 cases, there were 80 cases of dyspnea, and 70 cases of hypoxemia. The imaging examination showed pulmonary infiltration. Through the treatment with plasmapheresis, hormone shock, immune inhibitors and other drugs, 10 patients underwent plasma exchange, 7 cases were effective; 29 cases were treated with gamma globulin, 21 cases were effective; 74 patients received high-dose corticosteroid, 47 cases were effective; 21 cases were given mechanical ventilation, 8 cases were effective; 49 cases were treated with immunosuppressive drugs, 36 cases were effective; 12 cases received the bronchoalveolar lavage, 10 cases were effective. Conclusions DAH is a rare and life-threatening complications of SLE. Early diagnosis, the use of plasmapheresis combined with hormone shock and other supportive treatment, preventing and treating the complications actively, will improve the patient's clinical manifestations and prognosis effectively.