Acute massive pulmonary hemorrhage after craniotomy in a patient with systemic lupus erythematosus

Acute massive pulmonary hemorrhage (AMPH) is a rare life-threatening complication of systemic lupus erythematosus (SLE). We report a lupus nephritis patient with active disease, in whom AMPH developed after craniotomy for brain injury. Computed tomography scan of the brain revealed a subdural hemorrhage and intracranial hemorrhage with a midline shift, indicating increased intracranial pressure (IICP). Neurogenic pulmonary edema (NPE) was suspected 5 days after operation due to dyspnea and chest radiograph findings of bilateral infiltrations. Seven days after the craniotomy, she had bloody sputum, a sudden drop in blood hemoglobin level (from 12.3 g/dL to 8.8 g/dL), and diffuse alveolar infiltrates in both lung fields. All of these features were characteristic manifestations of AMPH. Complete blood count disclosed mild thrombocytopenia (88,000/mm3). We believe that in an SLE patient, IICP or NPE might be risk factors in the development of AMPH.