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KMID : 0383819880350030210
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Tuberculosis and Respiratory Diseases
1988 Volume.35 No. 3 p.210 ~ p.215
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A Case of Diffuse Alveolar Hemorrhage Associated with Overlap syndrome
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Abstract
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Respiratory system is frequently involved in various connective tissue diseases. Pleural
effusion, interstitial fibrosis, pulmonary vasculitis, and pneumonia are well known
pulmonary manifestations. Diffuse intra-alveolar pulmonary hemorhage with or without
hemoptysis is also a relatively common finding at the autopsy of systemic lupus
erythematosus patients. But there was no report of pulmonary hemorrhage associated
with connective tissue disease in Korea.
Recently we experienced a case with overlap syndrome (rheumatoid arthritis, systemic
lupus erythematosus and polymyositis) associated with diffuse intra-alveolar hemorrhage
which was proven by the transbronchial lung biopsy and hemosiderin laden macrophages
in the bronchoalveolar lavage fluid.
The patient is a 15 year-old school girl who has sufferred from rheumatoid arthritis
for 3 years and developed dyspnea 3 weeks before admission. She has a typical malar
rash, oropharyngeal ulceration, mild proximal muscle weakness and tenderness with
elevation of muscle enzymes. She also has crackes on both lower lung fields with
interstitial marking on chest X-ray Pulmonary function test revelaled severe restrictive
defect with low DLCO. Transbronchial biopsy showed severe intra-alveolar
hemorrhage with mild interstitial changes. Many hemosiderin-laden macrophages were
found at the bronchoalveolar lavage fluid.
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KEYWORD
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