A Case of Acute Breathlessness in Systemic Lupus Erythematosus: A Devastating Complication

Abstract

Diffuse Alveolar Haemorrhage (DAH) is a severe respiratory complication of Systemic Lupus Erythematosus (SLE) and is associated with high mortality. A drop in blood haemoglobin, dyspnoea, haemoptysis, diffuse infiltrates on chest imaging indicate this devastating diagnosis. The DAH is rare in SLE, even rarer in the early months in an undiagnosed patient. Defective phagocytosis, immune complexes, depletion of complement, and autoantibodies are the aetiologies. Immune complex induced alveolar capillaritis is the cause of DAH. This report was about a 28-year-old female, who presented with acute worsening dyspnoea on a background history of inflammatory joint pain, digital gangrene, alopecia, oral ulcers, and Raynaud’s phenomenon. She was subsequently diagnosed as SLE with DAH. This case was rare as she presented with DAH in the early months of her disease. The patient was started on high dose steroid, cyclophosphamide, and plasmapheresis, but succumbed on day 14 of admission due to high disease activity and respiratory failure. DAH carries very high mortality rate even in the best centres, even when diagnosed early.

Keywords

• diffuse alveolar haemorrhage
• immune complex
• steroid