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lupus pneumonitis
Epidemiology:
- 10% of lupus cases
Pathology:
1) diffuse alveolar damage
2) may progress to pulmonary fibrosis &, eventually, pulmonary hypertension
Clinical manifestations:
1) severe dyspnea
2) tachypea
3) fever
4) pleurisy
5) cough
6) basilar rales
7) hypoxia
8) no apparent infection
Laboratory:
1) thoracentesis with pleural fluid analysis if pleural effusion
- pleural fluid is exudate by Light's criteria
2) complete blood count
3) serum chemistries, evidence of active lupus (see lupus)
Special laboratory:
- bronchoalveolar lavage may show increased leukocytes, predominantly lymphocytes Radiography
- chest X-ray
1) atelectasis & pulmonary infiltrates predominantly in lower lobes
2) pleural effusion in 30%
- CT of thorax
1) diffuse pulmonary infiltrates in both lungs
2) ground glass opacities in multiple lobes
Differential diagnosis:
- pneumonia
- pulmonary alveolar hemorrhage
Management:
1) generally responds to glucocorticoids
2) see lupus
General
systemic lupus erythematosus
References
- eMedicine Case, Kulkarni R & Cho J, 2005
http://www.eMedicine.com
- Medical Knowledge Self Assessment Program (MKSAP) 18,
American College of Physicians, Philadelphia 2018