RHUPUS (Rheumatoid arthritis + Systemic lupus erythematosus) with acute interstitial lung disease

Abstract

Introduction: Patients with systemic lupus erythematosus (SLE) often develop pleuropulmonary manifestations during their disease course. The clinical presentation is nonspecific, making diagnosis challenging because it overlaps with other causes of acute respiratory failure in both clinical and radiological aspects. High-resolution computed tomography (HRCT) is crucial for identifying characteristic disease patterns. Treatment typically involves high-dose systemic corticosteroids and immunosuppressants.

Case Presentation: A 33-year-old woman with a history of rheumatoid arthritis, SLE (RHUPUS), and mitral regurgitation was admitted to the intensive care unit (ICU) for dyspnea at rest and respiratory failure. She was initially treated for acute pulmonary edema, but her symptoms did not fully resolve.

Clinical Findings: Immunology tests confirmed active SLE and rheumatoid arthritis. Chest CT revealed interlobular septal thickening and bilateral central parenchymal consolidations. Bronchoalveolar lavage culture returned negative. These findings are consistent with acute interstitial lung disease.

Therapeutic Management: She was started on corticosteroids and mycophenolate, achieving an adequate response. The patient was discharged from the ICU to continue specialist management until her condition improved and valve replacement surgery could be scheduled. She was discharged on hydroxychloroquine and mycophenolate.