Cases by Disease Category
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Case No : 1283 Date 2022-05-23
- Courtesy of Suji Lee, Young Joo Suh / Severance hospital
- Age/Sex 60 / F
- Chief ComplaintFever PHx: Lupus nephritis
Discussion
Diagnosis With Brief Discussion
- Diagnosis
- Acute lupus pneumonitis
- Radiologic Findings
- Fig 1. Chest PA shows patchy GGO and consolidation in the right upper and middle lung fields.
Fig 2-5. CT scans reveal diffuse, ill-defined, and patchy/nodular GGO/consolidations in both lungs.
- Brief Review
- Thoracic involvement of systemic lupus erythematous (SLE) includes pleura effusion or pleural thickening (40-60%), pulmonary hemorrhage (14%), diaphragmatic dysfunction (18%), fibrosing alveolitis (3%)-subpleural reticular opacities, and lupus pneumonitis (rare). Acute lupus pneumonitis is a rare SLE manifestation, reported in 1-4% of patients. The clinical features are fever, cough, dyspnea, hemoptysis, and hypoxemia. It may be difficult to distinguish acute lupus pneumonitis from severe infection and ARDS. It is usually prudent to treat for infection initially, and once the infection has been ruled out, the clinician needs to think about the possibility of pulmonary involvement of SLE and treat with immunosuppressive therapy. Treatment mainly consists of corticosteroids and other immunosuppressants such as cyclophosphamide or azathioprine. Mortality has been described as being up to 50% in a case series.
Acute lupus pneumonitis manifests as unilateral or bilateral patchy consolidation, typically in the lung bases, resulting from alveolar capillary injury leading to edema and hemorrhage. An accompanied pleural effusion is often present. Focal consolidation from acute pneumonitis may be difficult to differentiate from that due to pneumonia, and, given that infection is more common, it is imperative to exclude an infectious source with both clinical and laboratory evaluation before considering lupus pneumonitis. Unlike other collagen-vascular diseases such as rheumatoid arthritis and scleroderma, chronic interstitial pneumonitis and pulmonary fibrosis occur in less than 3% of SLE patients and may represent sequelae of acute pneumonitis.
- References
- Lalani TA, Kanne JP, Hatfield GA, Chen P. Imaging findings in systemic lupus erythematosus. Radiographics. 2004;24(4):1069-86.
- Keywords
- Acute lupus pneumonitis,
No. of Applicants : 99
- ▶ Correct Answer : 30/99, 30.3%
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- - , Japan CHIAKI SATO
- - Vita Hospital , Brazil DIOGO LAGO PINHEIRO
- - Scans world , India PHILSON JOSEPH MUKKADA
- - Cabinet Capricorne, clinique sainte-clotilde , Reunion FABIEN HO
- - Seoul Medical Center , Korea (South) HYUK GI HONG
- - Chonbuk National University Hospital , Korea (South) JUNGHWAN KIM
- - Korea University Guro Hospital , Korea (South) HEEJUN PARK
- - The University of Tokyo Hospital , Japan TOSHIHIRO FURUTA
- - Inje University Pusan Paik Hospital , Korea (South) JIYEON HAN
- - Chonnam National University Hwasun Hospital , Korea (South) MYUNG WON SONG
- - Soonchunhyang University Hospital Bucheon , Korea (South) YE RIN KIM
- - Diskapi Yildirim Beyazit Hospital, Ankara , Turkey MERIC TUZUN
- - Chungbuk National University Hospital , Korea (South) MIHYEON PARK
- - University of Tsukuba, Dept of Radiology , Japan MANABU MINAMI
- - none , Mongolia MUNKHGEREL DAVAA
- - Eskisehir Sehir Hastanesi , Turkey MURAT SAHIN
- - Other , Korea (South) DONGYOUNG JEONG
- - Chonnam National University Hwasun Hospital , Korea (South) JEONG YEOP LEE
- - Osmania Medical College, Hyderabad , India PURUSHOTHAMA RAO TUMMALA
- - Asan Medical Center , Korea (South) BYUNGSOO IM
- - Chonnam National University Hospital , Korea (South) KIM SANG GYUN
- - Other , Korea (South) KYU-CHONG LEE
- - , Korea (South) SEUNG HOON OH
- - Seoul National University Bundang Hospital , Korea (South) YOONAH DO
- - Chonbuk National University Hospital , Korea (South) MINJEE KIM
- - , France HALIMSKI STANISLAU
- - Chungbuk National University Hospital , Korea (South) HYE SOO CHO
- - Yonsei University,Severance Hospital , Korea (South) SEO BUM CHO
- - Ichinomiya Nishi Hospital , Japan Takao Kiguchi
- - the first affiliatited hospital of nanjing medical univercity , China HAI XU
- ▶ Correct Answer as Differential Diagnosis : 14/99, 14.1%
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- - Saitama-Sekishinkai Hosptal , Japan MIHOKO YAMAZAKI
- - Jichi Medical University Hospital , Japan JUN KANZAWA
- - NIMS, HYDERABAD , India BHASKAR K
- - Tiger Gate Hospital , Japan SHIN-ICHI CHO
- - Other , Korea (South) SEONGSU KANG
- - Gifu University Hospital , Japan Yo Kaneko
- - Kyoto University Hospital , Japan YASUHISA KURATA
- - , Korea (South) YEONG UK HWANG
- - Pusan National University Yangsan Hospital , Korea (South) JI HWAN KIM
- - Chonbuk National University Hospital , Korea (South) DONG HAN SHIN
- - Nerimahikarigaoka hospital , Japan TAKANA HAYASHI
- - Sotiria Hospital, Athens , Greece VASILIOS TZILAS
- - , Japan YUKI HAYASHI
- - Jiangsu province hospital , China WANGJIAN ZHA
- ▶ Semi-Correct Answer : 12/99, 12.1%
-
- - Wakayama Red Cross Hospital , Japan TOMOAKI OTANI
- - Mayo Clinic , United States AKITOSHI INOUE
- - National Center of Neurology and Psychiatry , Japan MOTO NAKAYA
- - , Italy PAOLO BALDASSARI
- - Ichinomiya Nishi Hospital , Japan CHIHIRO KIGUCHI
- - Chungbuk National University Hospital , Korea (South) JIYUN KANG
- - Japanese Red Cross Medical Center , Japan YASUSHI AOYAGI
- - The University of Tokyo Hospital , Japan RYO KUROKAWA
- - , Korea (South) CHAEHUN LIM
- - , United States HIROAKI TAKAHASHI
- - Holy Family Hospital , India RAJESH GOTHI
- - The University of Tokyo Hospital , Japan HIROSHI TAKUMIDA
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