This document discusses the case of a 31-year-old woman referred for fever of 1 month duration. She was diagnosed with systemic lupus erythematosus based on her symptoms and test results. She developed new onset cough and chest pain while being treated with steroids. Imaging showed consolidation and effusions. Antibiotics did not improve her symptoms, shifting suspicion to lupus pneumonitis. Increasing steroids dosage resolved her symptoms. The document then provides an overview of lupus pneumonitis, its presentation, diagnostic evaluation and treatment.

1. Chair:- Prof. Dr. C Jayakumar
Presented by:- Dr Shybin Usman

2.  Maya
 31 years old
 Housewife
 2 Children

3.  Referred from local hospital
 c/o fever of 1 month duration
 Treatment till then unsuccessful
 Common infective causes ruled out
 Next line of workup started

4.  Pt had :-
 Arthritis
 Oral ulcers
 Serositis (pleural and pericardial effusions)
 Anaemia + High LDH + DCT positivity
 Anti ds-DNA positivity

5. Systemic Lupus
Erythematosus

6.  Started on steroids
 Pt afebrile by end of 1st week
 General condition improved

7.  New c/o cough and recurrence of fever
 Pt in 2nd week as IP
 Lt sided chest pain
 Scanty expectoration

10.  Pt on steroids
 New onset cough and pleuritic pain
 New patches on chest X-Ray
 First suspect:-
 INFECTIVE AETIOLOGY
 Added antibiotics
 CT chest taken

13.  Consolidation with air bronchogram in the
apicoposterior segment of left upperlobe
 Minimal right pleural effusion with basal
atelectasis
 Moderate pericardial effusion

14.  After 2 weeks of antibiotic therapy
 Bouts of fever persisting
 Cough persisting
 Chest pain has become right sided
 Repeat chest X-Ray

16.  Suspicion shifted to the next accused:-
Lupus Pneumonitis

17.  Steroid dose hiked
 Fever disappears
 Cough subsides
 Chest pain subsides
 Chest X-Ray repeated after 1 week

19.  Pt discharged
 Repeat chest X-Ray @ 2 weeks follow-up

21. An overview

22.  Common
 Pleurisy in 33%
 Pleural thickening
 Effusions :-
 Small, bilateral
 Exudate
 ANA, anti ds-DNA & LE cells in fluid

23.  Dyspnoea with lung volume loss
 CXR –
 Small clear lung fields
 Bilateral high diaphragm
 Theories –
 Diaphragmatic dysfunction
 Multiple small infarcts (due to vasculitis)

24.  Dramatic and severe complication
 10% patients
 SLE flare associated
 Fever, dyspnoea, hypoxemia
 Haemoptysis rare
 Tachypnea, crackles (fine/coarse)
 CXR – Diffuse infiltrates (mimic ARDS)
 Diffuse alveolar inflammation, vasculitis and
haemorrhage

25. Lupus Pneumonitis Acute Infection
CRP ↑ ↑↑
CO Transfer ↑/↓ N
BAL Haemosiderin laden Infective Organism
macrophages
Definitive investigation :- Open-lung biopsy

26.  Rx :-
 High dose Steroids / Immunosuppressants
 Mortality ≈ 50%

27.  Atelectasis (rarely clinically significant)
 Bronchiolitis obliterans
 Interstitial fibrosis (rare)
 Restrictive PFT
 Thromboembolism