Systemic lupus-induced diffuse alveolar hemorrhage treated with extracorporeal membrane oxygenation: a case report and review of the literature. J Intensive Care Med 2014;29(2):104-9
Date
06/12/2013Pubmed ID
23753220DOI
10.1177/0885066612464335Scopus ID
2-s2.0-84896143139 (requires institutional sign-in at Scopus site) 28 CitationsAbstract
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.
Author List
Patel JJ, Lipchik RJAuthors
Randolph J. Lipchik MD Professor in the Medicine department at Medical College of WisconsinJayshil Patel MD Associate Professor in the Medicine department at Medical College of Wisconsin
MESH terms used to index this publication - Major topics in bold
AdultDiagnosis, Differential
Diastole
Dyspnea
Echocardiography
Electronic Health Records
Extracorporeal Membrane Oxygenation
Female
Hemorrhage
Humans
Lupus Erythematosus, Systemic
Pulmonary Alveoli
Radiography, Thoracic
Treatment Outcome
Ventricular Dysfunction, Right
Wisconsin