Rituximab: an emerging treatment for recurrent diffuse alveolar hemorrhage in systemic lupus erythematosus

Lupus. 2015 Jun;24(7):756-9. doi: 10.1177/0961203314564235. Epub 2014 Dec 19.

Abstract

Diffuse alveolar hemorrhage (DAH) is a rare manifestation of systemic lupus erythematosus (SLE) and is associated with high mortality rates. Treatment typically consists of aggressive immunosuppression with pulse-dose steroids, cyclophosphamide, and plasma exchange therapy. Mortality rates remain high despite use of multiple medical therapies. We present a case of recurrent DAH in a 52-year-old female with SLE after a deceased donor renal transplant who was successfully treated with rituximab. Our report highlights the pathophysiologic importance of B-cell-mediated immunosuppression in SLE-associated DAH and suggests that rituximab may represent a viable alternative to cyclophosphamide in the treatment of this disease. We also review eight other reported cases of rituximab use in SLE-associated DAH.

Keywords: Systemic lupus erythematosus; renal lupus; vasculitis.

Publication types

  • Case Reports

MeSH terms

  • Female
  • Hemorrhage / drug therapy*
  • Humans
  • Immunologic Factors / administration & dosage*
  • Lung Diseases / drug therapy*
  • Lung Diseases / pathology
  • Lupus Erythematosus, Systemic / drug therapy*
  • Lupus Erythematosus, Systemic / pathology
  • Lupus Erythematosus, Systemic / physiopathology*
  • Lupus Nephritis / physiopathology
  • Middle Aged
  • Pulmonary Alveoli / pathology
  • Recurrence
  • Rituximab / administration & dosage*
  • Vasculitis / physiopathology

Substances

  • Immunologic Factors
  • Rituximab