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Volume 38, Number 1, February 2005

Acute massive pulmonary hemorrhage after craniotomy in a patient with systemic lupus erythematosus


Shu-Jen Chang, Yu-Shu Yen, An-Ping Huo, Shinn-Shing Lee, De-Feng Huang
Section of Allergy, Immunology, and Rheumatology, Department of Medicine, Cheng Hsin Rehabilitation Medical Center, Taipei; Section of Allergy, Immunology, and Rheumatology, Department of Medicine, Veterans General Hospital, Taipei; Department of Neurosurgery, Veterans General Hospital-Taipei; and Department of Medicine, National Yang-Ming University, Taiwan

Received: February 2, 2003    Revised: December 23, 2003    Accepted: June 16, 2004   

 

Corresponding author:

Dr. De-Feng Huang, Section of Allergy, Immunology, and Rheumatology, Department of Medicine, Veterans General Hospital-Taipei, No.201, Sec.2, Shih-pai Road, Taipei 11217, Taiwan. E-mail: dfhuang@vghtpe.gov.tw This e-mail address is being protected from spam bots, you need JavaScript enabled to view it

 



 

Methods:

Acute massive pulmonary hemorrhage (AMPH) is a rare life-threatening complication of systemic lupus erythematosus (SLE). We report a lupus nephritis patient with active disease, in whom AMPH developed after craniotomy for brain injury. Computed tomography scan of the brain revealed a subdural hemorrhage and intracranial hemorrhage with a midline shift, indicating increased intracranial pressure (IICP). Neurogenic pulmonary edema (NPE) was suspected 5 days after operation due to dyspnea and chest radiograph findings of bilateral infiltrations. Seven days after the craniotomy, she had bloody sputum, a sudden drop in blood hemoglobin level (from 12.3 g/dL to 8.8 g/dL), and diffuse alveolar infiltrates in both lung fields. All of these features were characteristic manifestations of AMPH. Complete blood count disclosed mild thrombocytopenia (88,000/mm3). We believe that in an SLE patient, IICP or NPE might be risk factors in the development of AMPH .

 



 

Key words:

Central nervous system diseases, intracranial pressure, pulmonary edema, systemic lupus erythematosus



 



 

J Microbiol Immunol Infect 2005;38:69-72.