Two autopsy cases of systemic lupus erythematosus died of pulmonary hemorrhage

A wide variety of clinical and histologic pulmonary manifestations have been documented in patients with systemic lupus erythematosus (SLE). These include infection, lupus pleuritis and atelectasis. However, clinical discriptions are few in number with regard to pulmonary hemorrhage and its etiology. Here we report two cases of SLE patients complicated with pulmonary hemorrhage. Case 1. A 22-year-old woman suffered from polyarthralgia, butterfly rash, Raynaud's phenomenon, general edema, and later cough, hemosputum and dyspnea. Renal insufficiency with elevated BUN of 140mg/dl and severe proteinuria was noted with a pulmonary X-ray finding of lung edema and pleural effusion. These findings were not improved by the treatment with steroid but improved by dialysis. Autopsy findings showed a severe blood congestion in the lungs with intraalveolar hemorrhage. Alveolar walls were thick and destructed. Rapidly progressive glomerulonephritis was also noted with deposits of IgG and C3. Case 2. A 24-year-old woman suffered from arthralgia, slight fever, general fatigue and hemosputum. A chest roentgenogram disclosed an interstitial infiltration. No renal damage was found. Autopsy findings showed a blood congestion in the lung and hemorrhage in the alveolar cavity. Membrano-proliferative glomerulonephritis was noted with a slight thickening of basement membrane. As a cause of hemorrhage, severe congestion due to uremia was considered in case 1 and lupus pneumonitis most probably due to immune deposits, though they were not examined, was considered in case 2.