Pulmonary Manifestations of Systemic Lupus Erythematosus

Two Systemic Lupus Erythematosus Patients With Severe Pleurisy: Similar Presentations, Different Causes

“…Tetracycline or talc pleurodesis have been used for recurrent large effusions (7). Of note, uncontrolled pleural inflammation may lead to fibrothorax and trapped lung (7,36). Our case 1 responded dramatically to decortication, supporting its therapeutic role in severe forms of this disease.…”

“…However, if the presentation is severe (as in our cases), or if the patient does not respond to NSAIDs in a few days, moderate to high doses of GC may be used (7). The most severe cases may also be treated with IV pulse GC.…”

“…In rare cases where GC cannot be tapered because of severe (such as in our case 1) or recurrent inflammation, other immunosuppressive agents, such as azathioprine and MMF, may be needed. Tetracycline or talc pleurodesis have been used for recurrent large effusions (7). Of note, uncontrolled pleural inflammation may lead to fibrothorax and trapped lung (7,36).…”

“…Despite extensive evaluations with imaging, bronchoscopy, and pathology (using 2 different sampling techniques in case 2, specifically, percutaneous CT-guided needle biopsy and TBBX), the correct diagnoses were not identified and therefore, appropriate care was delayed. Not only does VATS offer diagnostic value, it may have a therapeutic benefit (7,36). Case 1 improved rapidly after VATS, before one would expect a benefit from rituximab or an increased dose of MMF.…”

Pulmonary Manifestations of Systemic Lupus Erythematosus

“…(Haupt et al, 1981;Orens et al, 1994;Quadrelli et al, 2009) It is important to note that lung involvement is proportionately more common in men. (Kamen & Strange, 2010) Any part of the pulmonary system can be affected including airways, lung parenchyma, pulmonary vasculature, pleura and diaphragm. (Gross et al, 1972;Haupt et al, 1981;Kamen & Strange, 2010;Orens et al, 1994;Quadrelli et al, 2009;Weinrib et al, 1990) If SLE develops after age 49 years, it has a higher incidence of serositis, pulmonary involvement and mortality.…”