Systemic lupus erythematosus is associated with numerous pleuropulmonary complications. Although uncommon, diffuse alveolar hemorrhage represents a life-threatening cause of acute respiratory failure among patients with lupus. Here, we present a 24-year-old woman with a history of lupus who developed hemoptysis and respiratory failure associated with diffuse radiographic infiltrates and anemia. Bronchoscopy confirmed diffuse alveolar hemorrhage. She was managed with supportive care, plasmapheresis, and immunosuppressive pharmacotherapy leading to sustained resolution of her pulmonary hemorrhage and respiratory failure. We then review the available literature on the pathophysiology and management of lupus-associated diffuse alveolar hemorrhage, which centers on supportive care, reversal of coagulopathy, and immunosuppressive measures. SUMMARY FOR TABLE OF CONTENTS A 24-year-old woman with a history of systemic lupus erythematosus presented with hemoptysis, diffuse radiographic infiltrates, anemia, and respiratory failure; bronchoscopy confirmed diffuse alveolar hemorrhage. Her condition was managed with supportive care, plasmapheresis, and immunosuppression with glucocorticoids, cyclophosphamide, and mycophenolate mofetil. Diffuse alveolar hemorrhage represents an uncommon but life-threatening complication of lupus with a growing evidence base to support acute and chronic management strategies centered on immunosuppressive pharmacotherapy.

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RATIONALE: While parental anxiety is commonly observed clinically in the food-allergic (FA) population, studies of FA patients and their parents have mainly focused on using broader measures (e.g., quality of life (QoL)) to capture this phenomenon. Moreover, measures of QoL have often been equated to measures of health anxiety. The current study sought to use factor analyses to determine whether parental anxiety and quality of life are distinct constructs. METHODS: Canadian parents of children with FA were invited to participate in an online survey through Food Allergy Canada about their generalized (state) anxiety using the State Trait Anxiety Inventory (STAI-S) and their QoL using the Food Allergy Quality of Life Parental Burden (FAQoL-PB) questionnaire. Factor analyses were used to evaluate the psychometric properties of STAI-S and its relation to FAQoL-PB. RESULTS: Factor analysis was first conducted separately for each measure-STAI-S yielded two factors (presence versus absence of anxiety) and the FAQoL-PB also yielded two factors (physical limitations on life versus emotional distress). Subsequently, factor analysis of all items (20 items from STAI-S and 17 items from FAQoL-PB) combined resulted in four factors that were orthogonal. These findings suggest that, although significantly correlated (r 50.54, p<0.001), parental anxiety and QoL are two distinct constructs. CONCLUSIONS: While it is very useful to understand the quality of life and parental burden as it relates to parenting children with FA, our findings demonstrate the importance of developing a separate measure for understanding food allergy-associated parental anxiety.