Asseri AA, Al-Murayeh R, Abudiah AM, Elgebally EI, Aljaser AM. A case report of pediatric systemic lupus erythematosus with diffuse alveolar hemorrhage following COVID-19 infection: Causation, association, or chance?
Medicine (Baltimore) 2022;
101:e30071. [PMID:
35984167 PMCID:
PMC9387659 DOI:
10.1097/md.0000000000030071]
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Abstract
RATIONALE
Diffuse alveolar hemorrhage (DAH) is a rare manifestation of childhood systemic lupus erythematosus (SLE) that can be life-threatening. Several reports have linked previous or concurrent coronavirus disease (COVID-19) infections with a high prevalence of autoimmune and autoinflammatory disorders.
PATIENT CONCERNS
We report a case of a 13-year-old female who presented with DAH due to SLE 2 months after a laboratory-confirmed severe COVID-19 infection.
DIAGNOSES
The patient was diagnosed with DAH due to SLE 2 months after a laboratory-confirmed severe COVID-19 infection.
INTERVENTIONS AND OUTCOMES
The patient was treated with intravenous methylprednisolone pulse, broad-spectrum antibiotics, and supportive measures. In addition, she received 6 sessions of plasma exchange and maintenance methylprednisolone therapy (2 mg/kg/day). The patient then improved and was discharged on prednisolone, hydroxychloroquine, and azathioprine.
LESSONS
We suggest plasmapheresis be considered a treatment for SLE-associated DAH in the context of active disease when conventional treatment has failed to induce a rapid response. In addition, further studies are needed to assess the role of COVID-19 as an autoimmune disease trigger, particularly for SLE.
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