PULMONARY HEMORRHAGE AND IMMUNE-COMPLEX DEPOSITION IN THE LUNG - COMPLICATIONS IN A PATIENT WITH SYSTEMIC LUPUS-ERYTHEMATOSUS

Abstract

A patient with systemic lupus erythematosus (SLE) was admitted with an acute illness characterized by dyspnea, hemoptysis, fever and diffuse infiltrates revealed by chest roentgenograms. An open-lung biopsy specimen showed massive intrapulmonary hemorrhage; immunofluorescence and EM examinations showed granular deposits of Ig[immunoglublin]G with the alveolar walls and pulmonary vessels. Rare, widely scattered foci of infiltration of vessel and alveolar walls by polymorphonuclear leukocytes were also observed. The patient was treated with large doses of prednisone and her condition improved but she had a 2nd episode of massive hemorrhage 8 days after discharge despite maintenance of the prednisone therapy. Her condition again improved over several days and she has had no pulmonary symptoms for 9 mo. In some instances pulmonary hemorrhage in patients with SLE may be mediated by polymorphonuclear leukocytes attracted by immune-complex deposits.