No abnormal finding except a few mucosal erythematous lesion

 BAL : Increasingly bloody fluid in successive regurged lavage

           AFB stain(-) Silver stain(-),  Bacterial culture(-) Fungal culture(-)
          Viral culture (-) : influenza A/B, parainfluenza, RSV, Adenovirus, CMV

 TBLB  
   


Acute pulmonary Involvement of the SLE
Infectious pneumonia
Acute lupus pneumonitis
   Patchy consolidation , often found at the lung bases with pleural effusion
Pulmonary alveolar hemorrhage
  Uniform, ill-defined, centrilobular nodules without zonal predominancy

  Ground-glass attenuation and airspace consolidation

  Rapid development and improvement

  Abnormal thickening of the interlobular septa as interstitial fibrosis

Pulmonary aoveolar hemorrhage in SLE
Clinical Presentation

    Dyspnea, Fever, Cough, Hemoptysis(54%)

    Decrease of Hb(>1d/dl)

    Newly developed pulmonary infiltrate

    Potentially catastrophic complication (mortality ratio exceeds 50% or more)

    Rarely seen as initial manifestation

    Commonly associated with lupus nephritis : pulmonary-renal syndrome

Diagnosis
    Elevated diffusing capacity of the lung for CO(>30%)

    Bronchoscopy with BAL

       Aspiration of the successive aliquots yields increasingly bloody BAL fluid

      Hemosiderin-laden macrophage

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