PULMONARY MANIFESTATIONS OF SYSTEMIC LUPUS ERYTHEMATOSUS: REVIEW OF TWELVE CASES OF ACUTE LUPUS PNEUMONITIS
PULMONARY MANIFESTATIONS OF SYSTEMIC LUPUS ERYTHEMATOSUS: REVIEW OF TWELVE CASES OF ACUTE LUPUS PNEUMONITIS
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系统性红斑狼疮的肺部表现：急性狼疮性肺炎12例回顾
作者：
R. Matthay;M. Schwarz;T. Petty;R. Stanford;R. Gupta;S. Sahn;J. Steigerwald
急性狼疮性肺炎是系统性红斑狼疮的临床表现在本系列的12例中的6。临床表现为严重呼吸困难、呼吸急促、发热和动脉低氧血症。影像学检查结果包括腺泡填充模式，这是总是发现在下叶和10例双侧。研究未能发现感染是急性肺浸润的原因。所有患者均接受氧气和皮质类固醇治疗; 7例接受硫唑嘌呤治疗。6名患者存活，在急性疾病后14个月至4年临床良好。其中3例患者存在残留间质浸润，伴持续性肺功能检查异常，提示进展为慢性间质性肺炎。4例患者的肺组织切片显示透明膜和间质水肿（4例）、急性肺泡炎（2例）、小动脉血栓形成（1例）和显著的淋巴细胞间质性肺炎伴机化性细支气管炎（1例）。
Acute lupus pneumonitis was the presenting manifestation of systemic lupus erythematosus in six of 12 cases in this series. The clinical picture was characterized by severe dyspnea, tachypnea, fever and arterial hypoxemia. Radiographic findings included an acinar filling pattern which was invariably found in the lower lobes and was bilateral in 10 of the cases. Studies failed to reveal evidence of infection as a cause of the acute pulmonary infiltrates. All patients were treated with oxygen and corticosteroids; seven received azathioprine. Six patients survived and are clinically well 14 months to four years following their acute illness. Three of these patients have residual interstitial infiltrates with persistent pulmonary function test abnormalities indicating progression to chronic interstitial pneumonitis. Histologic sections of the lungs available from four patients revealed hyaline membranes and interstitial edema (four cases), acute alveolitis (two cases), arteriolar thrombosis (one case) and a prominent lymphocytic interstitial pneumonitis with organizing bronchiolitis (one case).