[A case of systemic lupus erythematosus who developed nodular shadows in the lung in parallel with the disease activity].

A 35-year old woman was admitted to our hospital in April 1991 due to the appearance two nodular shadows on chest X-ray. The patient's past medical history was as follows; In 1986, she developed polyarthralgia, facial eruptions and Raynaud's phenomenon which was treated with prednisolone. In 1988, investigations revealed proteinuria where by the diagnosis of SLE complicated with lupus nephritis was established. Subsequently, treatment with cyclophosphamide was carried out. However, in January 1991, there was further increase in urine proteins in accompaniment with systemic eruptions. In addition, laboratory findings showed an increasing titre of anti-DNA antibody and decreasing serum compliments. In April 1991, as indicated before, a chest X-ray revealed nodular shadows in the right upper and lower lung fields, therefore, a transbronchial lung biopsy was performed. The histology revealed inflammatory infiltrates in the bronchoalveolar tissue, fibrosis of the septa- and exudates in the alveolar space. These findings suggested fibrosing alveolitis. It was true considered that these lesions in the lung were associated with the exacerbation of SLE. In view of this, the dose of prednisolone was increased to 60 mg/day. Consequently, the nodular shadows regressed and the clinical course of SLE improved. It is well appreciated that some patients with SLE develop variable pulmonary involvement, however, this case is of great interest due to the fact that multiple nodular shadows on chest X-ray are very rare in SLE.