Rheumatology International

, Volume 29, Issue 9, pp 1113–1115 | Cite as

Treatment of intractable pulmonary hemorrhage in two patients with childhood systemic lupus erythematosus

Letter to the Editor

Abstract

Systemic lupus erythematosus (SLE) is a chronic autoimmune disease of unknown etiology with multisystem involvement. A number of pulmonary complications including pleuritis, pneumonitis, infectious pneumonia, and pulmonary hemorrhage, have been reported in patients with SLE. Pulmonary hemorrhage is a major life-threatening manifestation in children and adolescents with SLE. Mycophenolate mofetil is an immunosuppressive agent used in solid organ transplantation, and it may play an increasing role in autoimmune disease. In this report, we present two cases of childhood SLE with recurrent pulmonary hemorrhage, which were unresponsive to treatment with high-dose corticosteroids, cytotoxic therapy, IVIG, plasmaphoresis, and supportive therapy, but responded to IV mycophenolate mofetil. A multimodal therapy including mycophenolate mofetil was effective in treatment of these two children.

Keywords

Systemic lupus erythematosus Lupus pneumonitis Pulmonary hemorrhage Mycophenolate mofetil 

References

  1. 1.
    Dweik RA, Arroliga AC, Cash JM (1997) Alveolar hemorrhage in patients with rheumatic disease. Rheum Dis Clin North Am 23:395–410. doi:10.1016/S0889-857X(05)70336-7 PubMedCrossRefGoogle Scholar
  2. 2.
    Samad AS, Lindsley CB (2003) Treatment of pulmonary hemorrhage in childhood systemic lupus erythematosus with mycophenolate mofetil. South Med J 96:705–707. doi:10.1097/01.SMJ.0000054424.20202.7D PubMedCrossRefGoogle Scholar
  3. 3.
    Delgado EA, Malleson PN, Pirie GE et al (1990) The pulmonary manifestations of childhood onset systemic lupus erythematosus. Semin Arthritis Rheum 19:285–293. doi:10.1016/0049-0172(90)90051-G PubMedCrossRefGoogle Scholar
  4. 4.
    Asherson RA, Hackett D, Gharavi AE et al (1986) Pulmonary hypertension in systemic lupus erythematosus: a report of three cases. J Rheumatol 13:416–420PubMedGoogle Scholar
  5. 5.
    Asherson RA, Oakley CM (1986) Pulmonary hypertension and systemic lupus erythematosus. J Rheumatol 13:1–5PubMedGoogle Scholar
  6. 6.
    Schwab EP, Schumacher HR Jr, Freundlich B et al (1993) Pulmonary alveolar hemorrhage in systemic lupus erythematosus. Semin Arthritis Rheum 23:8–15. doi:10.1016/S0049-0172(05)80022-8 PubMedCrossRefGoogle Scholar
  7. 7.
    Miller RW, Salcedo JR, Fink RJ et al (1986) Pulmonary hemorrhage in pediatric patients with systemic lupus erythematosus. J Pediatr 108:576–579. doi:10.1016/S0022-3476(86)80839-3 PubMedCrossRefGoogle Scholar
  8. 8.
    Allison AC, Eugui EM (2000) Mycophenolate mofetil and its mechanisms of action. Immunopharmacology 47:85–118. doi:10.1016/S0162-3109(00)00188-0 PubMedCrossRefGoogle Scholar
  9. 9.
    Wang K, Zhang H, Li Y et al (2004) Efficacy of mycophenolate mofetil versus azathioprine after renal transplantation: a systematic review. Transplant Proc 36:2071–2072. doi:10.1016/j.transproceed.2004.07.059 PubMedCrossRefGoogle Scholar
  10. 10.
    Karim MY, Alba P, Cuadrado MJ et al (2002) Mycophenolate mofetil for systemic lupus erythematosus refractory to other immunosuppressive agents. Rheumatology (Oxf) 41:876–882. doi:10.1093/rheumatology/41.8.876 CrossRefGoogle Scholar
  11. 11.
    Ginzler EM, Dooley MA, Aranow C et al (2005) Mycophenolate mofetil or intravenous cyclophosphamide for lupus nephritis. N Engl J Med 353:2219–2228. doi:10.1056/NEJMoa043731 PubMedCrossRefGoogle Scholar
  12. 12.
    Kingdon EJ, McLean AG, Psimenou E et al (2001) The safety and efficacy of MMF in lupus nephritis: a pilot study. Lupus 10:606–611. doi:10.1191/096120301682430186 PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2009

Authors and Affiliations

  1. 1.Children’s Hospital Medical CenterTehran University of Medical SciencesTehranIran

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