Pulmonary aspergillosis and massive haemoptysis in systemic lupus erythematosus

Abstract

Invasive pulmonary aspergillosis is an increasingly important cause of infectious morbidity and mortality in the immunocompromised host, particularly in those patients receiving myelotoxic chemotherapy or immunosuppressive therapy. A 27-year-old research chemist with recently diagnosed systemic lupus erythematosus (SLE) treated with high-dose steroids presented to the intensive care unit (ICU) with Gram-negative septic shock and disseminated intravascular coagulation (DIC). At admission, the chest X-ray demonstrated diffuse bilateral pulmonary shadowing. She improved with antibiotic therapy. Pulsed cyclo-phosphamide was commenced two days after admission to ICU for suspected lupus cerebritis, which was confirmed at magnetic resonance imaging (MRI) scanning. Two weeks later she developed massive haemoptysis. Bronchial arteriograms demonstrated bleeding from the right upper lobe (RUL). In addition to confirming the primary bleeding site, bronchoscopy also demonstrated multiple friable, bleeding polypoid les...