October 1981

Pulmonary Disease and Hemorrhage in Systemic Lupus Erythematosus

Arch Intern Med. 1981;141(11):1555. doi:10.1001/archinte.1981.00340120163039

To the Editor.  —We read with interest the report by Marino and Pertschuk in the February 1981 Archives (141:201-203) describing three additional cases of systemic lupus erythematosus (SLE) with pulmonary hemorrhage. The clinical presentation of their patients was similar in many respects to that seen in the patients we have previously described.1 In our initial series of four patients, frank hemoptysis or respiratory failure was the initial pulmonary feature, and three of four patients demonstrated a sudden decrease in the hematocrit value.Our study results,1,2 in contrast to the results of Marino and Pertschuk, provide evidence favoring a type III immune pathogenesis for this lesion (Figure).3 Multifactor analysis of possible pathogenetic mechanisms responsible for pulmonary hemorrhage disclosed immune complex deposition as the only factor present in all of our patients with hemorrhagic alveolitis.1 Similarly, all of our patients demonstrated elevated serum immune complex levels and hypocomplementemia

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