Systemic Lupus-Induced Diffuse Alveolar Hemorrhage Treated With Extracorporeal Membrane Oxygenation: A Case Report and Review of the Literature

J Intensive Care Med. Mar-Apr 2014;29(2):104-9. doi: 10.1177/0885066612464335. Epub 2012 Oct 22.

Abstract

Objectives: We report the case of a 28-year-old patient with systemic lupus erythematosus (SLE) with rapid onset of dyspnea and hemoptysis found to have diffuse alveolar hemorrhage (DAH) with refractory hypoxemia successfully treated with venovenous extracorporeal membrane oxygenation (ECMO). The discussion includes clinical presentation, diagnosis, management, outcome, and a review of the available adult literature on the use of ECMO in patients with DAH.

Design: Case report.

Setting: Froedtert Hospital and the Medical College of Wisconsin.

Data sources: Data were collected from the patient's electronic medical record and the hospital radiology database.

Conclusions: Diffuse alveolar hemorrhage secondary to SLE is quite rare. The adult literature on the utilization of ECMO for DAH is limited mostly to antineutrophil cytoplasmic antibody (ANCA)-associated alveolar hemorrhage and a few reports of nonvasculitis DAH. Bleeding has been a contraindication to ECMO due to the need for systemic anticoagulation. Our case, along with a review of the literature, indicates that ECMO with anticoagulation can be safely utilized in patients with DAH. To our knowledge, this is the first reported adult case of DAH due to SLE successfully treated with ECMO.

Keywords: cardiac arrest; diffuse alveolar hemorrhage; extracorporeal membrane oxygenation; lupus; pericardial tamponade; refractory hypoxemia.

Publication types

  • Case Reports
  • Review

MeSH terms

  • Adult
  • Diagnosis, Differential
  • Diastole
  • Dyspnea / diagnosis
  • Dyspnea / etiology
  • Echocardiography
  • Electronic Health Records
  • Extracorporeal Membrane Oxygenation / statistics & numerical data*
  • Female
  • Hemorrhage / complications
  • Hemorrhage / etiology*
  • Hemorrhage / pathology
  • Hemorrhage / therapy
  • Humans
  • Lupus Erythematosus, Systemic / complications*
  • Lupus Erythematosus, Systemic / diagnosis
  • Pulmonary Alveoli / diagnostic imaging*
  • Radiography, Thoracic
  • Treatment Outcome
  • Ventricular Dysfunction, Right / diagnosis
  • Ventricular Dysfunction, Right / etiology*
  • Wisconsin