A Fatal Case of Diffuse Alveolar Hemorrhage in the Setting of Systemic Lupus Erythematosus: A Case Report and Review of Noninfectious Causes of Acute Pulmonary Hemorrhage in Adults

Table 1

Most common noninfectious causes of diffuse alveolar hemorrhage.

Cause	Typical clinical presentation	Serologic and/or radiographic findings
SLE	Female, mean age of 27, often concurrent renal involvement, and other signs of connective tissue disease	ANA, anti-Smith and anti-dsDNA antibodies, hypocomplementemia (C3, C4, or CH50), and granular immune complex deposition on kidney biopsy by IF
Granulomatosis with polyangiitis	Male, mean age of 50, and involvement of upper and lower respiratory tract and kidneys	c-ANCA, anti-PR3 antibody, nodules and cavities on chest radiograph and/or CT scan, and negative or pauci-IC deposition kidney biopsy by IF
Microscopic polyangiitis	Associated focal segmental necrotizing glomerulonephritis with rare pulmonary involvement	p-ANCA, anti-MPO antibody, and negative kidney biopsy by IF
Goodpasture syndrome	Male, age in 20 s, smoker, and pulmonary and renal involvement	IgG anti-GBM antibody and C3, and linear pattern on kidney biopsy by IF
Antiphospholipid syndrome	Female, with the history of thrombotic events and miscarriage, may be in the setting of SLE or another systemic autoimmune disease	Anticardiolipin antibodies, anti-beta2 GPI antibodies, and/or lupus anticoagulant
Mitral stenosis or regurgitation	Intermittent chest pain, palpitations, and peripheral edema	Elevated BNP or N-terminal pro-BNP, Kerley B lines on chest radiograph and/or CT scan, enlarged left atrium on echocardiography; may be unilateral
Drug-related complication	History of exposure to following: abciximab, amiodarone, anticoagulants, carbimazole, crack cocaine, leflunomide, nitrofurantoin, penicillamine, propylthiouracil, sirolimus, TNF-α antagonist, and trimellitic anhydride	Clinical history and/or positive drug screening for cocaine abuse
Isolated pauci-immune pulmonary capillaritis	Isolated pulmonary involvement	No significant serologic or radiographic findings
Idiopathic pulmonary hemosiderosis	Children and young adults age < 30 years, chronic anemia, pulmonary fibrosis, and celiac disease (Lane-Hamilton syndrome)	Anti-tTG or antiendomysial antibodies (celiac disease)

ANA, antinuclear antibody; beta2 GPI, beta-2 glycoprotein I; BNP, brain natriuretic peptide; c-ANCA, cytoplasmic antineutrophil cytoplasmic antibodies; CT, computed tomography; dsDNA, double-stranded deoxyribonucleic acid; GBM, glomerular basement membrane; IC, immune complex; IF, immunofluorescence; MPO, myeloperoxidase; p-ANCA, perinuclear antineutrophil cytoplasmic antibodies; PR3, proteinase 3; SLE, systemic lupus erythematosus; TNF-α, tumor necrosis factor-alpha; tTG, tissue transglutaminase.