Subacute alveolar hemorrhage in a patient with systemic lupus erythematosus: an atypical and rare manifestation

Abstract

Objective: To report the case of a patient with systemic lupus erythematosus (SLE) who developed subacute diffuse alveolar hemorrhage, evidencing an unusual form of clinical presentation. Case Details: A 17-year-old female patient with SLE presented with a subacute respiratory condition of three months' duration, characterized  by dyspnea, fever, chest pain, and occasional episodes of hemoptysis. Upon admission, she was hemodynamically stable and eupneic. Examinations showed anemia, elevated inflammatory markers, and complement consumption, without renal dysfunction, associated with extensive diffuse and bilateral ground-glass opacities and severe pulmonary involvement. After excluding differential diagnoses, the diagnosis of diffuse alveolar hemorrhage (DAH) associated with SLE was established. The patient received pulse therapy with corticosteroids and cyclophosphamide, with favorable progress, without the need for mechanical ventilation or critical care. Final considerations: Subacute DAH is rare manifestation, especially when associated with SLE, reinforcing the importance of diagnostic suspicion in lupus patients. Timely management was crucial for the favorable outcome.