Abstract
Diffuse alveolar hemorrhage (DAH) is an uncommon but alarming manifestation of systemic lupus erythematosus (SLE). It can occur anytime during the disease course. Timely and appropriate management can lead to better results improving the patients condition. A 21-year-old female presented with fever for 1 month and progressive respiratory distress for 20 days. Laboratory tests revealed raised anti-nuclear antibody and anti-dsDNA along with low complement levels of C3 and C4. Her chest X-ray showed bilateral pleural effusion with diffuse reticulonodular opacities. Computed tomography thorax was done which was suggestive of areas of consolidation and alveolar nodular lesions in bilateral lung fields favoring diffuse alveolar hemorrhage. She was treated with intravenous pulse methylprednisolone, mycophenolate mofetil, and hydroxychloroquine and she improved. Lupus presenting with DAH as its initial manifestation is rare and has got worse prognosis with mortality approaching up to 50%. Therefore, the patient with diffuse alveolar hemorrhage should be evaluated for lupus as delay in initiation of therapy may lead to a rapid worsening of the patients condition.
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