Diffuse alveolar hemorrhage from systemic lupus erythematosus misdiagnosed as high altitude pulmonary edema.

UNLABELLED: A 26-year-old woman presented with dyspnea and dry cough soon after arriving on the Qinghai-Tibet Plateau (3650 m). Chest radiograph showed diffuse patchy infiltrates. The initial diagnosis was high altitude pulmonary edema (HAPE). However, the patient had no sputum or moist rales, and supplemental oxygen and intravenous aminophylline produced no improvement. Chest HRCT revealed symmetric and diffuse ground glass opacities. Further examination found anemia, leukopenia, urine abnormalities, and increased erythrocyte sedimentation rate. Antibodies for ds-DNA and ANA were positive. Hemoptysis and arthralgia developed after a few days. Finally the patient was diagnosed with diffuse alveolar hemorrhage secondary to systemic lupus erythemetosus.

CONCLUSION

When considering a diagnosis of HAPE, careful attention to physical signs, and a clinical course that is atypical for HAPE should prompt evaluation for other disease processes; HRCT can be useful in this setting.