Acute massive pulmonary hemorrhage after craniotomy in a patient with systemic lupus erythematosus

Shu-Jen Chang^1,2, Yu-Shu Yen³, An-Ping Huo², Shinn-Shing Lee¹, De-Feng Huang^4
1Section of Allergy, Immunology, and Rheumatology, Department of Medicine, Cheng Hsin Rehabilitation Medical Center, Taipei; ²Section of Allergy, Immunology, and Rheumatology, Department of Medicine, Veterans General Hospital, Taipei; ³Department of Neurosurgery, Veterans General Hospital-Taipei; and ⁴Department of Medicine, National Yang-Ming University, Taiwan

Received: February 2, 2003 Revised: December 23, 2003 Accepted: June 16, 2004

Corresponding author: Dr. De-Feng Huang, Section of Allergy, Immunology, and Rheumatology, Department of Medicine, Veterans General Hospital-Taipei, No.201, Sec.2, Shih-pai Road, Taipei 11217, Taiwan. E-mail:

Acute massive pulmonary hemorrhage (AMPH) is a rare life-threatening complication of systemic lupus erythematosus (SLE). We report a lupus nephritis patient with active disease, in whom AMPH developed after craniotomy for brain injury. Computed tomography scan of the brain revealed a subdural hemorrhage and intracranial hemorrhage with a midline shift, indicating increased intracranial pressure (IICP). Neurogenic pulmonary edema (NPE) was suspected 5 days after operation due to dyspnea and chest radiograph findings of bilateral infiltrations. Seven days after the craniotomy, she had bloody sputum, a sudden drop in blood hemoglobin level (from 12.3 g/dL to 8.8 g/dL), and diffuse alveolar infiltrates in both lung fields. All of these features were characteristic manifestations of AMPH. Complete blood count disclosed mild thrombocytopenia (88,000/mm³). We believe that in an SLE patient, IICP or NPE might be risk factors in the development of AMPH .

Key words: Central nervous system diseases, intracranial pressure, pulmonary edema, systemic lupus erythematosus

J Microbiol Immunol Infect 2005;38:69-72.