Exploring rituximab efficacy in systemic lupus erythematosus with pulmonary hemorrhage: a retrospective case series from a single center.

Abstract

Objectives: Pulmonary hemorrhage (PH) represents a rare complication in systemic lupus erythematosus (SLE). In this study, we conducted a thorough investigation into the clinical features, diagnosis, treatment modalities, and outcomes of patients with SLE-associated PH at our medical center. Additionally, a comparative analysis of clinical and laboratory parameters before and after rituximab therapy were performed to assess its efficacy in the management of SLE-associated PH.

Methods: Seven SLE-associated PH patients received rituximab therapy at Ruijin Hospital from October 2016 to March 2025 were retrospectively reviewed. The clinical manifestations, laboratory tests, chest CT images before and after treatment were recorded.

Results: Among the patients, five were female and two were male, with a median age at diagnosis of 29 years (IQR: 23-64 years). All patients manifested dyspnea, with hemoptysis occurring in 63.5% of cases. The respiratory manifestations of all seven enrolled patients quickly achieved complete recovery and radiographic scan revealed the reduction or complete disappearance of pulmonary infiltrates. The decreased hemoglobin levels quickly rebounded. There was a decrease in the levels of IgG, IgA and IgM concurrently with an increase in C3 and C4. The levels of anti-dsDNA antibodies and positive anti-phospholipid antibodies, SLEDAI-2 K Score showed significant decrease after rituximab treatment. Additionally, the proportion of CD19⁺ and CD20⁺ lymphocytes rapidly reduced after one month of rituximab treatment. The median follow-up duration after rituximab treatment was 23 months (IQR: 17-32 months). All seven patients achieved remission and did not experience a relapse of PH and SLE.

Conclusion: Careful consideration is needed in diagnosing SLE-associated PH in young female patients presenting with dyspnea, severe anemia, and pulmonary infiltration, even in the absence of hemoptysis. Rituximab likely demonstrates effectiveness in treating SLE-associated PH, indicating rituximab should be regarded as an alternative treatment for these patients. Key Points • Pulmonary hemorrhage (PH) is a rare yet severe complication of SLE. The treatment for PH in SLE remains uncertain, and evidence for rituximab use is limited to a few case reports. • This study presents a relatively large patient cohort, demonstrating that rituximab effectively resolves clinical symptoms and improves laboratory parameters. • Rituximab, by targeting B cells, may be a promising therapeutic option for SLE-associated PH.