We report the case of a 28-year-old patient with systemic lupus erythematosus (SLE) with rapid onset of dyspnea and hemoptysis found to have diffuse alveolar hemorrhage (DAH) with refractory hypoxemia successfully treated with venovenous extracorporeal membrane oxygenation (ECMO). The discussion includes clinical presentation, diagnosis, management, outcome, and a review of the available adult literature on the use of ECMO in patients with DAH.
Design:
Case report.
Setting:
Froedtert Hospital and the Medical College of Wisconsin. Data Sources: Data were collected from the patient’s electronic medical record and the hospital radiology database.
Conclusions:
Diffuse alveolar hemorrhage secondary to SLE is quite rare. The adult literature on the utilization of ECMO for DAH is limited mostly to antineutrophil cytoplasmic antibody (ANCA)-associated alveolar hemorrhage and a few reports of nonvasculitis DAH. Bleeding has been a contraindication to ECMO due to the need for systemic anticoagulation. Our case, along with a review of the literature, indicates that ECMO with anticoagulation can be safely utilized in patients with DAH. To our knowledge, this is the first reported adult case of DAH due to SLE successfully treated with ECMO.
Santos-OcampoAMandellBFesslerBJ. Alveolar hemorrhage in systemic lupus erythematosus: presentation and management. Chest. 2000;118(4):1083–1090.
7.
ZapolWMSniderMTHillJD. Extracorporeal membrane oxygenation in severe acute respiratory failure: a randomized prospective study. JAMA. 1979;242(20):2193–2196.
8.
MorrisAHWallaceCJMenloveRL. Randomized clinical trial of pressure-controlled inverse ratio ventilation and extracorporeal CO2 removal for adult respiratory distress syndrome. Am J Respir Crit Care Med. 1994;149(2 pt 1):295–305.[Erratum, Am J Respir Crit Care Med. 1994;149(3 pt 1):838.
9.
CombesABacchettaMBrodieDMüllerTPellegrinoV. Extracorporeal membrane oxygenation for respiratory failure in adults. Curr Opin Crit Care. 2012;18(1):99–104.
10.
PeekGJMugfordMTiruvoipatiR. Efficacy and economic assessment of conventional ventilatory support versus extracorporeal membrane oxygenation for severe adult respiratory failure (CESAR): a multicentre randomised controlled trial. Lancet. 2009;374(9698):1351–1363.
MariaaMVHollisterbRKaufmanJ. Case report: severe microscopic polyangiitis successfully treated with extracorporeal membrane oxygenation and immunosuppression in a pediatric patient. Curr Opin Pediatr. 2008;20(6):740–742.
13.
AgarwalHSTaylorMBGrzeszczakMJ. Extra corporeal membrane oxygenation and plasmapheresis for pulmonary hemorrhage in microscopic polyangiitis. Pediatr Nephrol. 2005;20(4):526–528.
14.
SidenHBSandersGMMolerFW. A report of four cases of acute, severe pulmonary hemorrhage in infancy and support with extracorporeal membrane oxygenation. Pediatr Pulmonol. 1994;18(5):337–341.
15.
AgarwalHSTaylorMBGrzeszczakMJ. Extra corporeal membrane oxygenation and plasmapheresis for pulmonary hemorrhage in microscopic polyangiitis. Pediatr Nephrol. 2005;20(4):526–528.
16.
SunLCTsengYRHuangSC. Extracorporeal membrane oxygenation to rescue profound pulmonary hemorrhage due to idiopathic pulmonary hemosiderosis in a child. Pediatr Pulmonol. 2006;41(9):900–903.
17.
Di MariaMVHollisterRKaufmanJ. Case report: severe microscopic polyangiitis successfully treated with extracorporeal membrane oxygenation and immunosuppression in a pediatric patient. Curr Opin Pediatr. 2008;20(6):740–742.
18.
HernandezMELovrekovicGSchearsG. Acute onset of Wegener’s granulomatosis and diffuse alveolar hemorrhage treated successfully by extracorporeal membrane oxygenation. Pediatr Crit Care Med. 2002;3(1):63–66.
19.
JosephMCharlesAG. Early extracorporeal life support as rescue for Wegener Granulomatosis with diffuse alveolar hemorrhage and acute respiratory distress syndrome: a case report and literature review. Pediatr Emerg Care. 2011;27(12):1163–1166.
20.
HartmannANordalKPSvennevigJ. Successful use of artificial lung (ECMO) and kidney in the treatment of a 20-year old female with Wegener’s syndrome. Nephrol Dial Transplant. 1994;9(3):316–319.
21.
DaimonSUmedaTMichishitaIWakasugiHGendaAKoniI. Goodpasture’s-like syndrome and effect of extracorporeal membrane oxygenator support. Intern Med. 1994;33(9):569–573.
22.
MatsumotoTUekiKTamuraS. Extracorporeal membrane oxygenation for the management of respiratory failure due to ANCA-associated vasculitis. Scand J Rheumatol. 2000;29(3):195–197.
23.
KotaniKIchibaSAndouM. Extracorporeal membrane oxygenation with nafamostat mesilate as an anticoagulant for massive pulmonary hemorrhage after living-donor lobar lung transplantation. J Thorac Cardiovasc Surg. 2002;124(3):626–627.
24.
RosengartenAElmorePEpsteinJ. Long distance road transport of a patient with Wegener’s Granulomatosis and respiratory failure using extracorporeal membrane. Emerg Med (Fremantle). 2002;14(2):181–187.
25.
AhmedSHAzizTCochranJHighlandK. Use of extracorporeal membrane oxygenation in a patient with diffuse alveolar hemorrhage. Chest. 2004;126(1):305–309.
26.
BalasubramanianSKRavindranathTChatterjeeSSosnowskiAFirminRK. Extracorporeal membrane oxygenation with lepirudin anticoagulation for Wegener’s granulomatosis with heparin-induced thrombocytopenia. ASAIO J. 2005;51(4):477–479.
27.
ZhongHChenJHLiSQJiangLYLiXHanBH. Extracorporeal membrane oxygenation for pulmonary hemorrhage in microscopic polyangiitis. Chin Med J (Engl). 2008;121(24):2622–2623.
28.
PretoriusVAlayadhiWModryD. Extracorporeal life support for the control of life-threatening pulmonary hemorrhage. Ann Thorac Surg. 2009;88(2):649–650.
29.
ZhenGXinLLi-yaJLing-fengX. Extracorporeal membrane oxygenation for the management of respiratory failure caused by diffuse alveolar hemorrhage. J Extra Corpor Technol. 2009;41(1):37–40.
30.
MorrisSHHaightAEKamatPFortenberryJD. Successful use of extracorporeal life support in a hematopoietic stem cell transplant patient with diffuse alveolar hemorrhage. Pediatr Crit Care Med. 2010;11(1):e4–e7.
31.
MongeroLBBrodieDCunninghamJ. Extracorporeal membrane oxygenation for diffuse alveolar hemorrhage and severe hypoxemic respiratory failure from silicone embolism. Perfusion. 2010;25(4):249–252.
32.
BarnesSLNaughtonMDouglassJMurphyD. Extracorporeal membrane oxygenation with plasma exchange in a patient with alveolar haemorrhage secondary to Wegener’s granulomatosis. Intern Med J. 2012;42(3):341–342.
