A rare case of non-resolving Pneumonia in the ICU

in Max Smart Super Speciality Hospital, Saket

Apr 18 , 2023

A 43-year-old woman was admitted to ICU for left upper lobe pneumonia with hypoxemic respiratory failure. CT thorax revealed consolidation with ground opacities in the left upper lobe and lingular segment. A bronchoscopy was done, and cultures were sterile. However, despite many courses of empiric wide-spectrum antibiotic treatment taken before admission, respiratory failure and radiological opacities persisted. A thorough workup was done, and infectious causes were ruled out. In view of the combination of pancytopenia, autoimmune haemolysis, and diuse lymphocytic infiltration of the lung, by CT-guided and transbronchial lung biopsy, with antinuclear antibodies (ANA) at a titer of 1:320 (homogenous pattern), U1 snRNP positive, she was diagnosed as systemic lupus erythematosus (SLE) with lupus pneumonitis.

Immunosuppressive therapy was initiated. She responded well to treatment clinically and radiologically and is presently under follow-up.

Therefore, a high degree of suspicion of autoimmune disorders like SLE are imperative in patients presenting to ICU with non-resolving pneumonia with negative infectious work-up, as early diagnosis and treatment can significantly alter mortality rate.

Treated by: