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(Chest. 2001;120:323.)
© 2001 American College of Chest Physicians

Alveolar Hemorrhage Associated With Antiphospholipid Syndrome

Franz J. Wiedermann, MD; Wolfgang Lederer, MD and Wolfgang Schobersberger, MD

The Leopold-Franzens-University of Innsbruck Innsbruck, Austria

Correspondence to: Franz J. Wiederman, MD, Department of Anesthesia and Intensive Care Medicine, Division of General and Surgical Intensive Care Medicine, The Leopold-Franzens-University of Innsbruck, Anichstrasse 35, A-6020 Innsbruck, Austria; e-mail: Franz.Wiedermann{at}uibk.ac.at

To the Editor:

Santos-Ocampo et al (October 2000)1 reviewed seven patients with systemic lupus erythematosus (SLE) admitted to the hospital with episodes of alveolar hemorrhage (AH). Recently, we published a case report of multiple organ dysfunction with acute respiratory failure due to AH associated with antiphospholipid antibodies in a 42-year-old woman with a medical history of antinuclear antibodies-negative SLE and antiphospholipid syndrome (APS).2

The term antiphospholipid syndrome was introduced to describe patients presenting with combination of recurrent arterial and venous thrombosis, recurrent fetal loss, often accompanied by thrombocytopenia, and elevations of serum antiphospholipid antibodies, eg, lupus anticoagulant (LA) and anticardiolipin antibodies. APS may present as a primary disorder in patients without other autoimmune diseases, or as a secondary disorder in SLE and other autoimmune diseases.3 An analysis of 29 studies yielded an average frequency of 35% for LA and 44% for anticardiolipin antibodies in SLE patients. The reported frequency of APS in patients with SLE ranges from 20 to 35%.4 The pulmonary manifestations of APS include multiple pulmonary emboli, major pulmonary arterial thrombosis or microthrombosis with or without capillaritis, pulmonary hypertension, and AH.5 The presence of antiphospholipid antibodies is not usually associated with hemorrhagic manifestations, and such an event occurring in a patient with the APS is usually due to deficiency of another coagulation factor, severe thrombocytopenia or the presence of severe uremia or hepatic disease. The pulmonary vasculature, however, because of unknown factors, may be susceptible to hemorrhage.5

In the report of Santos-Ocampo et al,1 one patient had a medical history of cerebral vascular accident from APS. We are interested to know if all patients were tested for antiphospholipid antibodies, eg, LA and anticardiolipin antibodies or anti-ß2-glycoprotein I antibodies, and AH could also be the result of APS in some of the patients.

References

  1. Santos-Ocampo, AS, Mandell, BF, Fessler, BJ (2000) Alveolar hemorrhage in systemic lupus erythematosus. Chest 118,1083-1090[Abstract/Free Full Text]
  2. Wiedermann, FJ, Mayr, A, Schobersberger, W, et al (2000) Acute respiratory failure associated with catastrophic antiphospholipid syndrome. J Intern Med 247,723-730[CrossRef][ISI][Medline]
  3. Kandiah, DA, Sali, A, Sheng, Y, et al (1998) Current insights into the "antiphospholipid" syndrome: clinical, immunological, and molecular aspects. Adv Immunol 70,507-563[ISI][Medline]
  4. Amigo, MC, Khamashta, MA, Hughes, GRV (1998) Antiphospholipid syndrome in SLE. Baillieres Clin Rheumatol 12,477-493[ISI][Medline]
  5. Asherson, RA, Cervera, R (1995) Review: antiphospholipid antibodies and the lung. J Rheumatol 22,62-66[ISI][Medline]




This Article
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