Saving the life of a 14-year-old patient with Lupus Erythematosus who was coughing up blood in critical condition

On July 7, Bach Mai Hospital informed its doctors that Pediatric Center saves life of 14-year-old patient with systemic lupus erythematosus who coughs up blood and has difficulty breathing.

The female patient was diagnosed with Systemic Lupus Erythematosus (SLE), treated at another central hospital and discharged. Three days after discharge, the child began coughing up fresh red blood continuously with little phlegm and a fever of 37.5-38 degrees Celsius. After a few hours, the child had difficulty breathing and was very tired, and was taken to the Pediatric Center for emergency care by her family.

Doctor Pham Cong Khac said the patient was admitted to the hospital in a critical state of hemoptysis, respiratory failure, circulatory failure and severe anemia. Upon admission, doctors thought of the complication of diffuse alveolar hemorrhage in SLE patients. This is a rare manifestation, occurring in only about 2% of SLE cases in children. When it occurs, diffuse alveolar hemorrhage complications often progress very quickly, causing acute respiratory failure, severe anemia and possibly death if not treated promptly. Chest CT scan images show lesions suggestive of diffuse alveolar hemorrhage.

Dr. Mai Thanh Cong - the doctor who manages the autoimmune patient group at the Pediatric Center shared that if the treatment of diffuse alveolar hemorrhage complications due to SLE is too late, the child can die quickly. However, if the pulmonary hemorrhage is due to infection, the use of high doses of immunosuppressants can make the child's infection worse.

The regimen of high-dose methylprednisolone combined with intravenous cyclophosphamide is the treatment of choice for patients with severe lupus with life-threatening organ involvement such as diffuse alveolar hemorrhage, central nervous system involvement, or severe nephritis. This decision requires careful consideration of risks and benefits, especially in a 14-year-old patient. Risks include bone marrow suppression, infection, and reproductive toxicity. However, the greatest benefit is survival in the acute phase and control of lupus disease activity.

Day 5 after treatment. The patient no longer had difficulty breathing and stopped coughing up blood, no longer needed ventilator support, especially the fever stopped after treatment with immunosuppressants.

Dr. Nguyen Thanh Nam - Director of the Pediatric Center, said this is a typical example showing the complexity and danger of systemic lupus erythematosus in children, especially the complication of diffuse alveolar hemorrhage (DAH) - an extremely rare complication with a mortality rate of up to 50%. The child's miraculous recovery is the result of rapid diagnosis, early treatment and close interdisciplinary coordination./.

(Vietnam+)

Source: https://www.vietnamplus.vn/cuu-song-benh-nhi-14-tuoi-mac-lupus-ban-do-ho-ra-mau-nguy-kich-post1048359.vnp