{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,27]],"date-time":"2026-06-27T23:18:22Z","timestamp":1782602302147,"version":"3.54.5"},"reference-count":23,"publisher":"American Academy of Pediatrics (AAP)","issue":"8","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2016,8,1]]},"abstract":"<jats:sec><jats:title>BACKGROUND:<\/jats:title><jats:p>Diffuse alveolar hemorrhage (DAH) is a devastating clinical syndrome characterized by a falling hematocrit, respiratory insufficiency, and radiographic evidence of pulmonary infiltrates. Literature regarding management of DAH in childhood-onset SLE (cSLE) is limited.<\/jats:p><\/jats:sec><jats:sec><jats:title>METHODS:<\/jats:title><jats:p>We reviewed the presentation, management, and outcome of DAH in a pediatric tertiary medical center with one of the largest cSLE cohorts in North America. During a 10 year period 7 of 410 children with cSLE had DAH.<\/jats:p><\/jats:sec><jats:sec><jats:title>RESULTS:<\/jats:title><jats:p>The majority of cSLE patients with DAH were male (71%) and Hispanic (57%). The median age at the time of DAH diagnosis was 14 years (range 3 -15 years). DAH was the presenting manifestation of cSLE in 29% of children; 71% presented with DAH within 3 months of their diagnosis. All patients had cough, 86% had dyspnea, and 29% had hemoptysis. All patients had anemia and 71% had thrombocytopenia. Eighty-six percent had hematuria\/proteinuria, and a positive anti-double stranded DNA antibody. Chest imaging showed diffuse ground glass opacities in all events. All patients developed respiratory insufficiency (29% supplemental oxygenation and 71% mechanical ventilation). Transfusions were required in 57% of cases. All patients received corticosteroids and additional immunomodulation to achieve disease control. Eighty-six percent of our DAH\/cSLE cohort survived their initial event (median follow-up 2.5 years). No survivor required supplemental oxygen or had a DAH recurrence.<\/jats:p><\/jats:sec><jats:sec><jats:title>CONCLUSIONS:<\/jats:title><jats:p>SLE should be in the hospitalist's differential diagnosis for any child with respiratory insufficiency, cytopenias, and\/or urinary abnormalities. Once cSLE is identified, initiation of aggressive immune suppression with multiple agents may enhance outcomes.<\/jats:p><\/jats:sec>","DOI":"10.1542\/hpeds.2015-0281","type":"journal-article","created":{"date-parts":[[2016,8,1]],"date-time":"2016-08-01T08:42:40Z","timestamp":1470040960000},"page":"496-500","source":"Crossref","is-referenced-by-count":21,"title":["Diffuse Alveolar Hemorrhage as a Manifestation of Childhood-Onset Systemic Lupus Erythematosus"],"prefix":"10.1542","volume":"6","author":[{"given":"Saimun","family":"Singla","sequence":"first","affiliation":[{"name":"Division of Allergy, Immunology, and Rheumatology, Texas Children\u2019s Hospital, Houston, Texas;"},{"name":"Department of Pediatrics, Baylor College of Medicine, Houston, Texas; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Debra L.","family":"Canter","sequence":"additional","affiliation":[{"name":"Division of Allergy, Immunology, and Rheumatology, Texas Children\u2019s Hospital, Houston, Texas;"},{"name":"Department of Pediatrics, Baylor College of Medicine, Houston, Texas; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Timothy J.","family":"Vece","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Baylor College of Medicine, Houston, Texas; and"},{"name":"Division of Pulmonology, Texas Children\u2019s Hospital, Houston, Texas"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eyal","family":"Muscal","sequence":"additional","affiliation":[{"name":"Division of Allergy, Immunology, and Rheumatology, Texas Children\u2019s Hospital, Houston, Texas;"},{"name":"Department of Pediatrics, Baylor College of Medicine, Houston, Texas; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marietta","family":"DeGuzman","sequence":"additional","affiliation":[{"name":"Division of Allergy, Immunology, and Rheumatology, Texas Children\u2019s Hospital, Houston, Texas;"},{"name":"Department of Pediatrics, Baylor College of Medicine, Houston, Texas; and"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"417","published-online":{"date-parts":[[2016,8,1]]},"reference":[{"issue":"5","key":"2021120817195360100_B1","doi-asserted-by":"crossref","first-page":"965","DOI":"10.1016\/S0033-8389(22)02097-8","article-title":"Diffuse pulmonary hemorrhage","volume":"29","author":"M\u00fcller","year":"1991","journal-title":"Radiol Clin North Am"},{"issue":"2","key":"2021120817195360100_B2","doi-asserted-by":"crossref","first-page":"295","DOI":"10.2214\/ajr.164.2.7839958","article-title":"Diffuse pulmonary hemorrhage: clinical, pathologic, and imaging features","volume":"164","author":"Primack","year":"1995","journal-title":"AJR Am J Roentgenol"},{"issue":"6","key":"2021120817195360100_B3","doi-asserted-by":"crossref","first-page":"545","DOI":"10.1097\/00005792-197811000-00005","article-title":"Pulmonary hemorrhage in systemic lupus erythematosus","volume":"57","author":"Eagen","year":"1978","journal-title":"Medicine (Baltimore)"},{"issue":"4","key":"2021120817195360100_B4","doi-asserted-by":"crossref","first-page":"1083","DOI":"10.1378\/chest.118.4.1083","article-title":"Alveolar hemorrhage in systemic lupus erythematosus: presentation and management","volume":"118","author":"Santos-Ocampo","year":"2000","journal-title":"Chest"},{"issue":"8","key":"2021120817195360100_B5","doi-asserted-by":"crossref","first-page":"872","DOI":"10.1177\/0961203312441047","article-title":"Alveolar hemorrhage: distinct features of juvenile and adult onset systemic lupus erythematosus","volume":"21","author":"Araujo","year":"2012","journal-title":"Lupus"},{"issue":"9","key":"2021120817195360100_B6","doi-asserted-by":"crossref","first-page":"1725","DOI":"10.1002\/art.1780400928","article-title":"Updating the American College of Rheumatology revised criteria for the classification of systemic lupus erythematosus","volume":"40","author":"Hochberg","year":"1997","journal-title":"Arthritis Rheum"},{"issue":"9","key":"2021120817195360100_B7","doi-asserted-by":"crossref","first-page":"866","DOI":"10.1093\/rheumatology\/34.9.866","article-title":"Adult- and childhood-onset systemic lupus erythematosus: a comparison of onset, clinical features, serology, and outcome","volume":"34","author":"Tucker","year":"1995","journal-title":"Br J Rheumatol"},{"issue":"12","key":"2021120817195360100_B8","doi-asserted-by":"crossref","first-page":"1485","DOI":"10.1016\/S0027-9684(15)31553-4","article-title":"Diffuse alveolar hemorrhage as an initial presentation of systemic lupus erythematosus","volume":"100","author":"Porres-Aguilar","year":"2008","journal-title":"J Natl Med Assoc"},{"issue":"3","key":"2021120817195360100_B9","first-page":"558","article-title":"Fatal pulmonary hemorrhage in systemic lupus erythematosus. 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