7. Acute Lupus Pneumonitis
• Late inspiratory crackles
• CT chest
– Ground glass ; Honey comb
• 67 gallium scintigraphy
– Increased uptake
• BAL
– Polys or lymphos
• Distinguish from alveolar hemorrhage by DLCO
• VAT or OPEN lung biopsy
8. Acute Lupus Pneumonitis
• Short term mortality 50 %
• LYMPHOS give good prognosis
• Eosinophils and neutros give poor prognosis
• Post partum lupus has bad prognosis
• Survivers have permanent functional
abnormalities ( restriction )
9. Treatment
• No Controlled Trials
• Only case reports and expert opinions
• Emperical Antibiotics pending culture results
• Prednisone 1-1.5 mg/kg/d
• If no response in 72 hours then PULSE
methylprednisolone upto 1 g 3 days and
• Cyclophosphamide
• For those with marked tachypnea or hypoxia or
hemorrhage give PULSE. No oral steroids
• DURATION ??
10. ILD
• 9 %
• Similar to IPF or Rheumatic
• BAL to exclude other causes
• Biopsy
11. ILD
• Chronic Pnumonitits or Fibrosis
• HRCT defines the type of ILD
– Ground glass with cellular infiltration ; Biopsy NSIP
– Reticular pattern ( fibrotic disease ) ; Biopsy UIP
12. Treatment ( no TRIALS )
• Differentiate between chronic pneumnitis and
fibrosis
• PNUEMONITIS
– Glucocorticoids
• Prednisolone 1-2 mg/kg
– And Cyclophasphamide usually IV
– Change to Azathioprine of MMF after 6-12 months
• FIBROSIS
– Perfenidone
