Severe Progressive Diffuse Alveolar Hemorrhage in a Patient with Systemic Lupus Erythematosus

Kusunoki, Munenori; Umegaki, Takeshi; Shoji, Tomohiro; Nishimoto, Kota; Anada, Natsuki; Ando, Akiko; Uba, Takeo; Oku, Kanako; Hakata, Saya; Hagihira, Satoshi; Kamibayashi, Takahiko

doi:10.1155/2018/9790459

Cited by 7 publications

(6 citation statements)

References 15 publications

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“…In one case report, airway pressure release ventilation-based respiratory management was found to be a useful method for respiratory care in patients with systemic lupus erythematosus (SLE) with severe DAH-induced hypoxaemia when used in combination with high-dose corticosteroid therapy and immunosuppressive therapy to control the exacerbation of SLE,17 but in our case, we have used the volume control assist mode along with prone position ventilation, leading to improvement.…”

Section: Discussionmentioning

confidence: 96%

Prone positioning in a patient with fat embolism syndrome presenting as diffuse alveolar haemorrhage: new perspective

et al. 2020

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Diffuse alveolar haemorrhage (DAH) is a rare complication of fat embolism syndrome leading to severe hypoxaemia due to the effusion of blood into the alveoli from the damaged pulmonary microvasculature. The management is usually supportive with patients being nursed in supine position. The use of prone position ventilation in a DAH has rarely been reported before. We report an interesting case of a 26-year-old male patient diagnosed with DAH caused by fat embolism in whom prone position ventilation improved the lung dynamics and oxygenation.

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Section: Discussionmentioning

confidence: 96%

Prone positioning in a patient with fat embolism syndrome presenting as diffuse alveolar haemorrhage: new perspective

et al. 2020

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“…DAH is a syndrome characterized by intraalveolar bleeding from damaged pulmonary vasculature, often leading to acute respiratory failure with a mortality rate of 20% [ 8 ]. The differential diagnosis of DAH is broad and includes certain drugs, coagulopathy, mitral stenosis, and autoimmune diseases.…”

Section: Discussionmentioning

confidence: 99%

A Fatal Case of Diffuse Alveolar Hemorrhage in the Setting of Systemic Lupus Erythematosus: A Case Report and Review of Noninfectious Causes of Acute Pulmonary Hemorrhage in Adults

Lundgren

Molitor

Spilseth

et al. 2021

Case Reports in Rheumatology

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Systemic lupus erythematosus (SLE) is an autoimmune connective tissue disease, characterized by autoantibody production and immune complex formation, that has the potential to affect virtually any organ. Pleuropulmonary involvement occurs in 50–70% and commonly manifests as pleuritis and pleural effusion. Diffuse alveolar hemorrhage (DAH) is a rare manifestation of SLE. Most cases of DAH occur in young adults with an underlying autoimmune disease such as systemic vasculitis or Goodpasture syndrome. SLE is typically lower on the list of initial differential diagnoses of DAH due to its rarity compared to other etiologies. We present a case of a patient with dyspnea on exertion, dry coughs, lower extremity edema, and intermittent periorbital edema who ultimately succumbed to respiratory failure secondary to DAH in the setting of SLE. The diagnosis of SLE was suspected clinically and confirmed at autopsy due to her rapid clinical deterioration. DAH requires prompt intervention, and management is guided by the underlying disease process. SLE is a potentially treatable disease; therefore, timely diagnosis is important in order to exclude other noninfectious causes of DAH (reviewed in this report) and to initiate appropriate therapy.

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“…[ 12 , 13 ] The mechanism underlying the inhalation of fluorescein in waterproofing spray induces macrophage infiltration, thickening of the alveolar septum, and pulmonary collapse, which are related to alveolar hemorrhage. [ 14 , 15 ] Other inhaled materials, such as mycotoxins, cadmium, and marijuana, are also reported to cause alveolar hemorrhage. [ 13 , 16 , 17 ] The face lotion involving in our case included many organic elements, such as oils, solvents, multivalent alcohols, and preservative agents, which were derived from plants.…”

Section: Discussionmentioning

confidence: 99%

Chronic eosinophilic pneumonitis due to the inhalation of aerosolized face lotion

et al. 2021

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Rationale: Inhalation of toxic agents can induce eosinophilic pneumonia. However, only a few case reports demonstrate that exposure to materials can induce chronic eosinophilic pneumonia (CEP). Here, we describe a rare case of CEP with mild alveolar hemorrhage due to the inhalation of aerosols from face lotion. This is the first report of eosinophilic pneumonia caused by face lotion exposure. Patient concerns: A 39-year-old woman was admitted to our hospital with cough and dyspnea for 2 months, which coincided when she started to use a new aerosolized face lotion. Laboratory findings showed high blood eosinophil levels, and chest computed tomography (CT) scans revealed bilateral peripheral consolidation and ground-glass opacity mainly in the left upper lobe. She underwent flexible bronchoscopy. Eosinophils in bronchoalveolar lavage fluid (BALF) were slightly elevated, and the gross appearance of BALF was bloody. The histological examination of the transbronchial lung biopsy showed infiltration of eosinophils and macrophages in alveolar septa with edema and without vasculitis and granuloma formation; a small number of hemosiderin-laden macrophages were also observed. An inhalation challenge test involving the face lotion was performed. Six hours after the test, the blood test showed an increased white blood cell (WBC) count, and chest radiography showed slight exacerbation. Forced vital capacity decreased the following day. Diagnosis: According to histological analysis and positive result of an inhalation challenge test, she was diagnosed with CEP with mild alveolar hemorrhage due to inhalation of aerosols from the face lotion. Interventions and outcomes: She gradually improved without medication after stopping the use of face lotion. Lessons: To the best of our knowledge, this is the first report of CEP with mild alveolar hemorrhage due to the inhalation of face lotion. Various inhaled agents, such as face lotion, can induce CEP in rare cases.

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Severe Progressive Diffuse Alveolar Hemorrhage in a Patient with Systemic Lupus Erythematosus

Cited by 7 publications

References 15 publications

Prone positioning in a patient with fat embolism syndrome presenting as diffuse alveolar haemorrhage: new perspective

Prone positioning in a patient with fat embolism syndrome presenting as diffuse alveolar haemorrhage: new perspective

A Fatal Case of Diffuse Alveolar Hemorrhage in the Setting of Systemic Lupus Erythematosus: A Case Report and Review of Noninfectious Causes of Acute Pulmonary Hemorrhage in Adults

Chronic eosinophilic pneumonitis due to the inhalation of aerosolized face lotion

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