pn Perinatology Perinatology 2508-4887 2508-4895 The Korean Society of Perinatology 10.14734/PN.2019.30.1.32 pn-30-32 Case Report Antepartum Diagnosis and Treatment of Diffuse Alveolar Hemorrhage in a Pregnant Woman with Systemic Lupus Erythematosus KimHa ShinMD 1 JeonHae SunMD 1 HanSoo JinMD 1 KimJi HoiMD 1 ChangJae HoonMD 1 ShinKichulMD 2 3 KimByoung JaeMD 1 4 LeeSeung MiMD, PhD 1 Department of Obstetrics and Gyne cology, Seoul National University College of Medicine, Seoul Department of Internal Medicine, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Seoul Department of Internal Medicine, Seoul National University College of Medicine, Seoul Department of Obstetrics and Gynecology, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Seoul, Korea Correspondence to Seung Mi Lee, MD, PhD Department of Obstetrics and Gynecology, Seoul National University College of Medicine, 103 Daehak-ro, Jongno-gu, Seoul 03080, Korea 03 2019 20 03 2019 30 1 32 35 24082018 09102018 10102018 Copyright © 2019 The Korean Society of Perinatology 2019 This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. Abstract

Diffuse alveolar hemorrhage (DAH) is a rare and life-threatening complication of systemic lupus erythematosus. Differential diagnosis and successful management of DAH can be problematic in pregnancy. We report a case of a 35-year-old pregnant woman who was presumptively diagnosed with DAH and treated during the antepartum period, resulting in symptomatic improvement and successful delivery after immunosuppressive treatment.

 Pregnancy complications Lupus erythematosus Systemic Lupus nephritis Hemorrhage Lung diseases References Lara AR Schwarz MI Diffuse alveolar hemorrhage Chest 2010137 116471 Martínez-Martínez MU Abud-Mendoza C Diffuse alveolar hemorrhage in patients with systemic lupus erythematosus. Clinical manifestations, treatment, and prognosis Reumatol Clin 201410 24853 Kamen DL Strange C Pulmonary manifestations of systemic lupus erythematosus Clin Chest Med 201031 47988 Pego-Reigosa JM Medeiros DA Isenberg DA Respiratory manifestations of systemic lupus erythematosus: old and new concepts Best Pract Res Clin Rheumatol 200923 46980 Zamora MR Warner ML Tuder R Schwarz MI Diffuse alveolar hemorrhage and systemic lupus erythematosus. Clinical presentation, histology, survival, and outcome Medicine (Baltimore) 199776 192202 Barile LA Jara LJ Medina-Rodriguez F García-Figueroa JL Miranda-Limón JM Pulmonary hemorrhage in systemic lupus erythematosus Lupus 19976 4458 Santos-Ocampo AS Mandell BF Fessler BJ Alveolar hemorrhage in systemic lupus erythematosus: presentation and management Chest 2000118 108390 Mitchell K Kaul M Clowse ME The management of rheumatic diseases in pregnancy Scand J Rheumatol 201039 99108 Erickson RW Franklin WA Emlen W Treatment of hemorrhagic lupus pneumonitis with plasmapheresis Semin Arthritis Rheum 199424 11423 Takada K Illei GG Boumpas DT Cyclophosphamide for the treatment of systemic lupus erythematosus Lupus 200110 15461 Martínez-Martínez MU Abud-Mendoza C Predictors of mortality in diffuse alveolar haemorrhage associated with systemic lupus erythematosus Lupus 201120 56874 Gaither K Halstead K Mason TC Pulmonary alveolar hemorrhage in a pregnancy complicated by systemic lupus erythematosus J Natl Med Assoc 200597 8313 Keane MP Van De Ven CJ Lynch JP 3rd McCune WJ Systemic lupus during pregnancy with refractory alveolar haemorrhage: recovery following termination of pregnancy Lupus 19976 7303 Blitz MJ Fleischer A Severe maternal morbidity associated with systemic lupus erythematosus flare in the second trimester of pregnancy Case Rep Obstet Gynecol 20182018 5803479 Figures

(A) Chest radiograph showing diffuse consolidation. (B) Chest computed tomography scan showing diffuse ground glass opacity and nodular consolidation.

Chest radiograph showing radiographic improvement.