A Clinical Experience of Pulmonary Alveolar Hemorrhage with Renal Involvement in Systemic Lupus Erythematosus

紅班性狼瘡併肺出血及腎病變之臨床經驗

張明揚(Ming-Yang Chang) ； 方基存(Ji-Tseng Fang) ； 陳永昌(Yung-Chang Chen) ； 黃秋錦(Chiu-Ching Huang)

《Acta Nephrologica》 14卷4期 (2000/10) Pp. 289-289

並列摘要

Objective: Pulmonary Alveolar Hemorrhage (PAH) is a life-threatening complication of systemic lupus erythematosus(SLE). This study is to describe our experience of the incidence, clinical manifestation, treatment and outcome of PAH in SLE patients.
Methods and materials: We performed a retrospective analysis on the medical records of all inpatients at Ghang Gung Memorial Hospital with a diagnosis of SLE and PAH from July 1994 to June 2001. Our inclusion criteria of PAH included at least here of the followings: pulmonary symptoms, new infiltrates on chest radiographs, a drop of hemoglobin of at least 0.5 g/dl, or bloody return on bronchoalveolar larvage with hemosiderin-containing macrophage.
Result:
From 3748 patients hospitalized with the diagnosis of SLE, eight patients of pulmonary hemorrhage were diagnosed. The incidence of pulmonary hemorrhage in SLE is 0.21%. The mean age was 37.3 years. All patients were female. Mean duration of SLE was 71.3 months. Two patients are at pregnancy in the 22 weeks and 29 weeks, respectively. The most common presenting symptoms are dyspnea (8/8) and fever (7/8). Hemoptysis was seen in only 4 patients initially. Renal involvement is the most common extrapulmonary presentation occurred in all patients. Anticardiolipin antibody was detected in two pregnant patients. The overall mortality rate was 50%. All patients had received high dose intravenous corticosteroid as initial treatment. 7 of 8 patients required ventilator support and 5 of 8 patients needed hemodialysis. Plasmapheresis was added in 3 patientes and one patient died. Combined plasmapheresis and continuous venovenous hemofiltration (CVVH) were emplyed in 2 pregnant patients who all survived and one patient cuccessfully delivered a lived baby later. No recurrence of PAH was note damong the 4 survived patients during a mean follow-up period of 35.3 months.
Conclusion: We concluded that the PAH is a rare and serious complication of SLE. Renal involvement is very frequently. Aggressive treatment with high dose intravenouse corticosteroid and a combination of plasmapheresis and CVVH can probably improve the outcome.