Tuberc Respir Dis.  1988 Sep;35(3):210-215. 10.4046/trd.1988.35.3.210.

A Case of Diffuse Alveolar Hemorrhage Associated with Overlap syndrome

• KMID: 2528606
• DOI: http://doi.org/10.4046/trd.1988.35.3.210

Abstract

Respiratory system is frequentl y involved in various connective tissue diseases. Pleural effusion, interstitial fibrosis, pulmonary vasculitis, and pneumonia are well known pulmonary manifestations. Diffuse intra-alveolar pulmonary hemorhage with or without hemoptysis is also a relatively common finding at the autopsy of systemic lupus erythematosus patients. But there was no report of pulmonary hemorrhage associated with connective tissue disease in Korea Recently we experienced a case with overlap syndrome (rheumatoid arthritis, systemic lupus erythematosus and polymyositis) associated with diffuse intra-alveolar hemorrhage which was proven by the transbronchial lung biopsy and hemosiderin laden macrophages in the bronchoalveolar lavage fluid. The patient is a 15-year-old school girl who has suffered from rheumatoid arthritis for 3 years and developed dyspnea 3 weeks before admission. She has a typical malar rash, oropharyngeal ulceration, mild proximal muscle weakness and tendemess with elevation of muscle enzymes. She also has crackes on both lower lung fields with increased interstitial marking on chest X-ray. Pulmonary function test revelaled severe restrictive defect with low D_LCO. Transbronchial biopsy showed severe intra-alveolar hemorrhage with mild interstitial changes. Many hemosiderin-laden macrophages were found at the bronchoalveolar lavage fluid.