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Pulmonary manifestations of systemic lupus erythematosus in adults

Authors
Paul F Dellaripa, MD
Sonye Danoff, MD, PhD
Section Editor
David S Pisetsky, MD, PhD
Deputy Editors
Helen Hollingsworth, MD
Monica Ramirez Curtis, MD, MPH

INTRODUCTION

At some time during their course, most patients with systemic lupus erythematosus (SLE) show signs of involvement of the lung, pulmonary vasculature, pleura, and/or diaphragm [1-3]. Pleurisy, coughing, and/or dyspnea are often the first clues either to lung involvement or to SLE itself [4]. In some cases, however, abnormal pulmonary function tests (PFTs) and/or chest radiographs may be detected in asymptomatic patients [5].

Patients with SLE and lung involvement must always be evaluated for infection, particularly due to bacteria or viruses. Given that many are immunocompromised, opportunistic infections (eg, mycobacteria or fungi) should also be considered [6,7].

Overviews of the clinical manifestations of SLE in adults and children and a review of pulmonary disease in children with SLE are presented separately. (See "Overview of the clinical manifestations of systemic lupus erythematosus in adults" and "Systemic lupus erythematosus (SLE) in children: Clinical manifestations and diagnosis", section on 'Pulmonary disease'.)

PLEURAL DISEASE

Pleural involvement is common in systemic lupus erythematosus (SLE), occurring in up to 93 percent in autopsy series, and can be manifest as pleuritic chest pain with or without pleural effusion. In contrast, spontaneous pneumothorax is rare [3].

Clinical manifestations — Inflammation of the pleura may cause chest pain in the absence of a pleural effusion on the chest radiograph. In this setting, it is often difficult to determine whether the chest pain represents pleuritis. The presence of a rub, which may be transient, facilitates the diagnosis of pleurisy.

                          

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Literature review current through: May 2016. | This topic last updated: Jan 12, 2016.
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