Systemic Lupus Erythematous(SLE) is a multisystem autoimmune disease. It has been identified as the underlying cause for death for an average 1,034 deaths from 2000 and 2014. Our cases highlight two rare but life threatening complications of SLE; Catastrophic antiphospholipid syndrome (CAPS) and Diffuse alveolar hemorrhage (DAH) with mortality as high as 50-90%. Both cases presenting with respiratory symptoms, required meticulous monitoring in ICU and initially treated with broad spectrum antibiotics However, unlike pneumonia these patients required immunosuppressive and plasmapheresis leading to clinical improvement.
Conflict(s) of Interest
References with DOI
1. Lawrence RC, Helmick CG, Arnett FC, Deyo RA, Felson DT, Giannini EH, Heyse SP, Hirsch R, Hochberg MC, Hunder GG, Liang MH, Pillemer SR, Steen VD, Wolfe F. Estimates of the prevalence of arthritis and selected musculoskeletal disorders in the United States. Arthritis & Rheumatism. 1998;41(5):778–99. https://doi.org/10.1002/1529-0131(199805)41:5<778::aid-art4>3.0.co;2-v
2. Helmick CG, Felson DT, Lawrence RC, Gabriel S, Hirsch R, Kwoh CK, Liang MH, Kremers HM, Mayes MD, Merkel PA, Pillemer SR, Reveille JD, Stone JH. Estimates of the prevalence of arthritis and other rheumatic conditions in the United States: Part I. Arthritis & Rheumatism. 2007;58(1):15–25. https://doi.org/10.1002/art.23177
3. CDC WONDER FAQ Help Contact Us WONDER Search [Internet]. Centers for Disease Control and Prevention. Centers for Disease Control and Prevention; [cited 2017Apr9]. Available from: https://wonder.cdc.gov/cmf-icd10.html
4. Kazzaz NM, Mccune WJ, Knight JS. Treatment of catastrophic antiphospholipid syndrome. Current Opinion in Rheumatology. 2016;28(3):218–27. https://doi.org/10.1097/bor.0000000000000269
5. Ednalino C, Yip J, Carsons SE. Systematic Review of Diffuse Alveolar Hemorrhage in Systemic Lupus Erythematosus. JCR: Journal of Clinical Rheumatology. 2015;21(6):305–10. https://doi.org/10.1097/rhu.0000000000000291
6. Patel JJ, Lipchik RJ. Systemic Lupus–Induced Diffuse Alveolar Hemorrhage Treated With Extracorporeal Membrane Oxygenation. Journal of Intensive Care Medicine. 2014;29(2):104–9. https://doi.org/10.1177/0885066612464335
Hasan, Badar; Asif, Talal; Hasan, Maryam; and Edrees, Amr
"Call for Vigilance – Red Flags in Systemic Lupus Erythematous,"
Marshall Journal of Medicine:
3, Article 5.
Available at: https://mds.marshall.edu/mjm/vol3/iss3/5