Rituximab: an emerging treatment for recurrent diffuse alveolar hemorrhage in systemic lupus erythematosus

Diffuse alveolar hemorrhage (DAH) is a rare manifestation of systemic lupus erythematosus (SLE) and is associated with high mortality rates. Treatment typically consists of aggressive immunosuppression with pulse-dose steroids, cyclophosphamide, and plasma exchange therapy. Mortality rates remain hi...

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Bibliographic Details
Published in:Lupus 2015-06, Vol.24 (7), p.756-759
Main Authors: Tse, J R, Schwab, K E, McMahon, M, Simon, W
Format: Article
Language:English
Subjects:
Female
Hemorrhage - drug therapy
Humans
Immunologic Factors - administration & dosage
Lung Diseases - drug therapy
Lung Diseases - pathology
Lupus Erythematosus, Systemic - drug therapy
Lupus Erythematosus, Systemic - pathology
Lupus Erythematosus, Systemic - physiopathology
Lupus Nephritis - physiopathology
Middle Aged
Pulmonary Alveoli - pathology
Recurrence
Rituximab - administration & dosage
Vasculitis - physiopathology
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Summary:Diffuse alveolar hemorrhage (DAH) is a rare manifestation of systemic lupus erythematosus (SLE) and is associated with high mortality rates. Treatment typically consists of aggressive immunosuppression with pulse-dose steroids, cyclophosphamide, and plasma exchange therapy. Mortality rates remain high despite use of multiple medical therapies. We present a case of recurrent DAH in a 52-year-old female with SLE after a deceased donor renal transplant who was successfully treated with rituximab. Our report highlights the pathophysiologic importance of B-cell-mediated immunosuppression in SLE-associated DAH and suggests that rituximab may represent a viable alternative to cyclophosphamide in the treatment of this disease. We also review eight other reported cases of rituximab use in SLE-associated DAH.
ISSN:0961-2033
1477-0962
DOI:10.1177/0961203314564235