Marked hyperbilirubinemia with Gilbert syndrome and immunohemolytic anemia

Abstract

The etiology of pulmonary hemorrhage in lupus is unclear. Fayemi 7 identified fibrinoid necrosis and vasculitis in pulmonary vessels of autopsied patients. Reports of electron-dense deposits in alveolar basement membranes observed by electron microscopy, low levels of C3, and the occurrence of pulmonary hemorrhage during the acute phases of SLE suggest that pulmonary hemorrhage may result from vascular injury mediated by immune complexes. Hemoptysis in a patient with SLE is more commonly associated with pulmonary infection, pulmonary emboli, and congestive heart failure. To ensure appropriate therapy, each of these possibilities must be investigated in the patient who has SLE with hemoptysis. However, pulmonary hemorrhage per se is a known, but often fatal, complication of SLE and prompt recognition is essential; early diagnosis and prompt treatment with steroids and positive end expiratory pressure, and concomitant therapy of thrombocytopenia with platelet transfusions, permitted the survival of our patient.