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Diffuse alveolar haemorrhage in SLE — SCE Acute Medicine MCQ

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HardMusculoskeletal systemDiffuse alveolar haemorrhage in SLESCE Acute Medicine

A woman with SLE develops hypoxaemia, haemoptysis, bilateral alveolar infiltrates, falling haemoglobin and rapidly progressive nephritic AKI. Infection samples have been obtained and critical-care support is underway. Which disease-directed treatment is most appropriate?

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Correct answer: A — Pulse glucocorticoid with cyclophosphamide or rituximab under specialist care

Explanation lettering: C = shown as B · D = shown as C · E = shown as D · B = shown as E

A is correct. Diffuse alveolar haemorrhage with rapidly progressive lupus nephritis is life-threatening organ-active SLE. After simultaneous infection evaluation and respiratory support, use high-dose glucocorticoid with intravenous cyclophosphamide, rituximab or their specialist-selected combination. Anticoagulation can worsen pulmonary bleeding, hydroxychloroquine is important background therapy but insufficient for this emergency, and diuresis does not treat capillaritis. Plasma exchange may be considered in selected refractory or overlapping syndromes, but evidence does not support it as universal monotherapy.

Reference: https://pmc.ncbi.nlm.nih.gov/articles/PMC13290301/