A case with complication of overload versus diffuse alveolar hemorrhage in the setting of systemic lupus erythematosus: a case report and literature review

Systemic lupus erythematosus (SLE) is a complex autoimmune disease characterized by its diverse clinical manifestations, affecting multiple organ systems. Overload and diffuse alveolar hemorrhage (DAH) are part of the many complications of SLE patients. Here, we present a known case of lupus that presented with symptoms resembling acute respiratory distress syndrome (ARDS). The patient exhibited markedly elevated pressures of 215 over 157 and demonstrated a high opacity on the initial hospital admission chest radiographs, which, upon further investigations, led to a differential diagnosis between pulmonary edema due to fluid overload and DAH. Relevant treatments were administered accordingly. Notably, in this case, despite the strong indication of DAH due to the remarkably low hemoglobin levels, the patient’s significant improvement resulted solely from treatments targeting fluid overload. Subsequently, a notable reduction in the patient’s chest radiographic opacity was observed.