A 35-year-old woman with SLE develops progressive dyspnea, pleuritic chest pain, and hemoptysis. CT pulmonary angiogram shows no PE. BAL shows hemosiderin-laden macrophages. The most likely diagnosis is:

• A Diffuse alveolar hemorrhage (DAH) ✓
• B Shrinking lung syndrome
• C Lupus pneumonitis
• D Pulmonary hypertension

Explanation

Diffuse alveolar hemorrhage is a life-threatening pulmonary complication of SLE caused by immune complex-mediated capillaritis. The triad of hemoptysis, diffuse alveolar infiltrates on CT, and hemosiderin-laden macrophages on BAL (without an infectious or PE cause) is diagnostic. Shrinking lung syndrome involves restricted lung volumes due to diaphragmatic weakness without alveolar bleeding. Lupus pneumonitis is an acute inflammatory interstitial process without alveolar hemorrhage. Pulmonary hypertension presents with dyspnea without hemoptysis or BAL findings.

Reference: Harrison's Principles of Internal Medicine, 21st ed.

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Written and medically reviewed by the StethoPrep medical team.