This document discusses lung manifestations of systemic lupus erythematosus (SLE), specifically focusing on acute lupus pneumonitis. It notes that acute lupus pneumonitis occurs in 1-12% of SLE patients and presents with fever, cough, pleurisy, infiltrates, and basal rales. Diagnosis involves ruling out infection, performing CT scans showing ground glass or honeycomb patterns, gallium scans showing increased uptake, and BAL showing polys or lymphocytes. Treatment typically involves high-dose corticosteroids like prednisone and possibly cyclophosphamide if no response, with a duration of treatment that is unclear. Mortality can be as high as 50% for acute lupus pneum

1. LUPUS PNEUMONITIS
Shirjeel Murtaza
MBBS

2. LUPUS

3. LUPUS or NO LUPUS
• Lupus erythematosus
• Lupus vulgaris
• Lupus pernio
• Lupus nephritis
• Lupus pneumonitis

4. LUNG MANIFESTATIONS OF SLE
• Infections
• Pleurisy 50 %
• Pleural Effusion 20 %
• Acute Lupus Pnemonitis
• ILD
• Pulmonary Hypertension
• Shrinking Lung Syndrome
• Pulmonary Hemorrhage
• COP
• Acute reversible hypoxia
• Pulmonary vono-occlusive disease
• ARDS
• Thromboembolism with APLAs

5. Acute Lupus Pneumonitis
• 1-12 %
• FEVER
• COUGH
• PLUERISY
• INFILTRATES
• BASAL RALES
• Effusion (50 %)
• No infection

6. Acute Lupus Pneumonitis
• Fibrosis
• Vasculitis
• Pneumonitis
• Alveolitis
• pleuritis

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

13. Final Message
• ALWAYS RULE OUT INFECTION first
• HIGH CRP = Infection

14. Thank you