Multi-target therapy in a lupus patient with diffuse alveolar hemorrhage

Lupus. 2023 Jan;32(1):142-148. doi: 10.1177/09612033221136971. Epub 2022 Nov 16.

Abstract

Background: Systemic lupus erythematosus (SLE) is an autoimmune disease based on the pathology of small-vessel inflammation, which can affect multiple organs. Diffuse alveolar hemorrhage (DAH) is a rare and severe complication of SLE with high mortality, most commonly seen in young women. It often appears along with clinical manifestations of sudden dyspnea, hemoptysis, and rapid onset of hypoxemia, which develops into respiratory failure and even multiple organs damage.

Case report: The case of a 28-year-old female who was diagnosed with SLE complicated with DAH is presented here. The patient, who experienced recurring DAH, responded poorly to the common therapy of high-dose glucocorticoid plus cyclophosphamide and plasma exchange. After the treatment was adjusted to a multi-target regimen of glucocorticoid, tacrolimus, mycophenolate mofetil, and belimumab, the symptoms began to improve.

Conclusion: The multi-target regimen may be a new treatment strategy of SLE complicated with DAH.

Keywords: Systemic lupus erythematosus; diffuse alveolar hemorrhage, mycophenolate mofetil; multi-target therapy.

Publication types

  • Case Reports

MeSH terms

  • Adult
  • Female
  • Glucocorticoids / therapeutic use
  • Hemorrhage / diagnosis
  • Humans
  • Lung Diseases* / complications
  • Lung Diseases* / etiology
  • Lupus Erythematosus, Systemic* / complications
  • Lupus Erythematosus, Systemic* / diagnosis
  • Lupus Erythematosus, Systemic* / drug therapy
  • Pulmonary Alveoli / pathology

Substances

  • Glucocorticoids