Diffuse alveolar hemorrhage as an initial presentation of systemic lupus erythematosus.

Diffuse alveolar hemorrhage is a rare but fatal complication in patients with systemic lupus erythematosus. It has rarely been reported to occur as the initial presentation in lupus patients. We report a 55-year-old female Jehovah's witness who presented with diffuse alveolar hemorrhage as the initial manifestation of systemic lupus erythematosus. She responded favorably to early intravenous pulse methylprednisolone and cyclophosphamide along with hemotherapy she accepted once over the course of her hospital stay. Initially, there was clinical improvement, but relapsing of her alveolar hemorrhage 15 days later. It is important to keep in mind that lupus patients can present initially with this lethal pulmonary complication. Early identification and initiation of therapy are crucial in order to affect survival of these patients.

Finger necrosis due to cryoglobulinemic vasculitis in association with membranous nephropathy.

Cryoglobulinemic vasculitis is a small vessel vasculitis that has been associated with chronic infections and autoimmune, lymphoproliferative, and neoplastic disorders. When no significant etiological factors are identified, it is called essential mixed cryoglobulinemia. A detailed and thorough laboratory investigation is required to exclude all possible causes of cryoglobulin formation. Although cryoglobulin testing is simple, careful temperature regulation is needed to avoid false-negative results. Consensus diagnosis should be developed and implemented for appropriate cryoglobulin detection and accurate clinical diagnosis for cryoglobulinemic vasculitis. Here we present an interesting, first-ever case report of a 54-year-old Hispanic-American woman with essential mixed cryoglobulinemia presenting with significant digital necrosis in association with membranous nephropathy.