Efficacy of Rituximab in a Systemic Lupus Erythematosus Patient Presenting with Diffuse Alveolar Hemorrhage

Abstract EN

Diffuse alveolar hemorrhage (DAH) is a life-threatening complication of systemic lupus erythematosus (SLE).

Although infrequent, its mortality is very high.

While there are no established therapeutic guidelines, DAH has been traditionally managed with high-dose intravenous (IV) corticosteroids, cyclophosphamide, and plasma exchange.

The efficacy of alternative therapies such as rituximab has been described only in a few cases.

Herein, we report a 25-year-old Hispanic man who presented with acute-onset SLE manifested by polyarthralgia, nephritis, seizures, pancytopenia, severe hypocomplementemia, and elevated anti-dsDNA antibodies.

His disease course was complicated by DAH.

His condition was refractory to high-dose intravenous (IV) methylprednisolone pulses, IV cyclophosphamide, and plasmapheresis.

Given the lack of clinical response, he was started on IV rituximab 375 mg/m2 weekly for a total of four courses.

He rapidly improved after the first two doses.

Over the next seven months, he did not present recurrent pulmonary symptoms.

Follow-up chest computed tomography did not show residual abnormalities.

This case, together with other reports, suggests that rituximab is an effective therapeutic option for DAH in SLE.