Diffuse Alveolar Hemorrhage, A Potentially Life-Threatening Manifestation in Systemic Lupus Erythematosus and the Antiphospholipid Syndrome

Diffuse alveolar hemorrhage (DAH) is a potentially life-threatening pulmonary manifestation that has been associated with various diseases. It is a medical emergency that requires prompt diagnosis and aggressive treatment. The clinical manifestations consist of hemoptysis, hypoxia, a drop in the hemoglobin level and new pulmonary infiltrates on chest X-ray. Infrequently, Systemic lupus erythematosus (SLE) and Antiphospholipid syndrome (APS) could be complicated by this severe pulmonary manifestation. The most common histologic lesion in SLE and Antiphospholipid Syndrome is pulmonary capillaritis. Corticosteroids with or without immunosuppressive agents such as cyclophosphamide are the mainstay of the therapy. Plasmapheresis, intravenous immunoglobulin or the newer biologic agents would be considered if there is a persistent lack of clinical response.