EVERY SYSTEM IN LUPUS ERYTHEMATOSUS

TOPIC: Pulmonary Manifestations of Systemic Disease TYPE: Fellow Case Reports INTRODUCTION: lupus erythematosus (lupus) is a chronic autoimmune condition that can present with mild symptoms or fulminant organ failure. manifestations include pleuritis, pneumonitis, alveolar hemorrhage and shrinking lung. We man no past medical history new diagnosis in the setting multi-organ failure diffuse hemorrhage. CASE PRESENTATION: A 32 year old was well until two weeks prior to admission when he began experience fever, cough dyspnea. He worsened, presented respiratory urgently intubated. born Southern California worked as patent examiner; had recent visits farms mold exposures did not smoke tobacco, vape use illicit drugs. acute kidney injury serum creatinine 2.38 mg/dL, HS-troponin elevation 65 ng/L, proBNP 29,249 pg/mL. Urinalysis showed 1+ protein, blood, 21-50 WBC, 6-10 RBC. There an enlarged cardiac silhouette, bilateral parenchymal opacities, pleural effusions on chest x-ray. Bronchoscopy revealed prominent mucosal erythema evidence bloody secretions all major bronchi; serial lavage demonstrated sequentially return. required vasopressors for shock, continuous renal replacement therapy. Echocardiogram severely depressed left ventricular ejection fraction (27%) moderate pericardial effusion without tamponade. Serologies high titer anti-double stranded DNA anti-Smith antibodies started pulse-dose steroids cyclophosphamide Kidney biopsy confirmed class IV active nephritis. DISCUSSION: In this case, systemic erythematosus, manifesting myocarditis, serositis, nephritis, significantly improved pulse dose has since complete recovery. uncommon but be due capillaritis, bland damage. The prevalence myocarditis patients about 10% commonly co-occurs pericarditis. For both associated lupus, recommended treatment methylprednisolone cyclophosphamide. CONCLUSIONS: This case represents three most life-threatening lupus: hemorrhage, Supportive care intensive unit included vasopressors, inotropes, subsequently recovery longer requiring dialysis; now hydroxychloroquine, mycophenolate mofetil, prednisone maintenance REFERENCE #1: Lara AR, Schwarz MI. Diffuse Chest. 2010 May;137(5):1164-71. doi: 10.1378/chest.08-2084. PMID: 20442117. #2: Muangchan C, van Vollenhoven RF, Bernatsky SR, Smith CD, Hudson M, Inanç Rothfield NF, Nash PT, Furie RA, Senécal JL, Chandran V, Burgos-Vargas R, Ramsey-Goldman Pope JE. Treatment Algorithms Lupus Erythematosus. Arthritis Care Res (Hoboken). 2015 Sep;67(9):1237-1245. 10.1002/acr.22589. 25777803. #3: Wijetunga Rockson S. Myocarditis erythematosus. Am J Med. 2002 Oct 1;113(5):419-23. 10.1016/s0002-9343(02)01223-8. 12401537. DISCLOSURES: No relevant relationships by Rebecca Sell, source=Web Response Lauren Sullivan,