13 Managing cardiovascular and lung disease in lupus

biopsy revealed Class III lupus nephritis, with scores of 9 and 2 for activity and chronicity, respectively.She was treated successfully with pulses of methylprednisolone and cyclophosphamide followed by prednisone 40 mg/day (subsequently tapered), hydroxychloroquine 400 mg/day, mycophenolate mofetil, calcium and vitamin D.In November 2023 she was admitted to hospital following a few days of fever, paleness, cough, dyspnea, and thoracic pain.On admission she presented hypotension and pulmonary crackles.Blood analysis showed leukopenia, lymphopenia, thrombocytopenia, and a 1.5 g/dL drop in hemoglobin level (compared to her previous one taken 20 days before), C3 and C4 hypocomplementemia and proteinuria of 1800 mg/24 h.A chest X-ray and thoracic CT scan showed bilateral patchy infiltrates and ground glass opacities.A bronchoalveolar lavage fluid was performed and revealed hemosiderin-laden macrophages.All cultures were sterile.With a diagnosis of acute diffuse alveolar hemorrhage (DAH), she was treated with pulse of methylprednisolone and cyclophosphamide.Treatment with plasmapheresis and rituximab was not necessary due to her favourable progress. 1-3