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treatment (e.g., drug-induced thrombocytopenia), or to an infection (e.g., aspergillosis).
Clinical features of patients with pulmonary hemorrhage include hemoptysis,
tachypnea, tachycardia, and dyspnea; respiratory function may deteriorate rapidly if the
process is not controlled. Chest radiographs show fluffy infiltrates resembling
pulmonary edema. CBCs often reveal a dramatic drop in hemoglobin and a low platelet
count. Diagnosis of a pulmonary hemorrhage may be confirmed by PFTs, including
DLCO . Intra-alveolar blood increases CO absorption, making it one of the few
conditions that results in an abnormally high DLCO . Bronchoalveolar lavage or lung
biopsy still may be needed in some patients in whom Pneumocystis or Aspergillus
infection remains a concern.
Management should include ventilatory support and blood products as needed, plus
high doses of IV corticosteroids. If bleeding is related to thrombocytopenia, platelet
transfusion is indicated. Tracheal lavage with epinephrine may be necessary, depending
on the severity and progression of the process.
Occasionally, children with lupus may develop interstitial pneumonitis. Cultures of
the blood and respiratory secretions, bronchial washings, transtracheal aspirate, or lung
biopsy may be necessary to exclude opportunistic infections. Supportive therapy should
include increased concentrations of oxygen, adequate pulmonary toilet, and antipyretic
drugs. Corticosteroids or immunosuppressive agents may lead to dramatic
improvement once infections have been excluded.
GI Complications. Peritonitis and GI hemorrhage are emergencies associated with
SLE. Drug-induced gastric ulcer and pancreatitis also occur. Often it is difficult to
determine the nature of an intra-abdominal catastrophe.
Peritonitis may be a feature of the disease itself (serosal inflammation) or may be
caused by secondary infection or visceral perforation. It is important to remember that
clinical findings of peritoneal irritation may be masked by corticosteroid therapy.
Aspiration of the peritoneal fluid is essential if the cause of the peritoneal effusion is in
doubt. Cell counts higher than 300/mm3 should be considered indicative of infection.
Peritonitis due to serositis may be treated with NSAIDs, and corticosteroids may be
added if there is an inadequate response.
An acute abdomen in SLE may be the result of bowel ischemia, infarction, or

perforation, in addition to the occasional unrelated occurrence of intussusception or
appendicitis (see Chapters 12 Abdominal Distension , 53 Pain: Abdomen , and 91
Gastrointestinal Emergencies ).
Pancreatitis must be considered in children with SLE and abdominal symptoms.
Although corticosteroids may cause pancreatitis, in most cases it is prudent to assume
that pancreatitis is secondary to active SLE and to increase immunosuppression to treat
it. Recovery may be protracted, during which time the patient may have to be
maintained on parenteral hyperalimentation.