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Mesenchymal stem cell transplantation for diffuse alveolar hemorrhage in SLE

Nature Reviews Rheumatology volume 6, pages 486–489 (2010)Cite this article

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Abstract

Background. A 19-year-old girl was diagnosed with systemic lupus erythematosus, based on findings of arthritis, malar rash, positive antinuclear antibody test and high levels of antibodies to double-stranded DNA. Two months after diagnosis, the patient presented with a sudden drop in blood hemoglobin level. Several days later, she developed bloody sputum, rapidly progressive dyspnea and hypoxemia. High-resolution CT showed diffuse alveolar infiltrates in both lung fields.

Investigations. Physical examination, complete blood count, erythrocyte sedimentation rate, urinalysis, 24-h urine protein excretion, fecal occult blood test, d-dimer test, acid hemolysis test, activated partial thromboplastin time and prothrombin time, direct and indirect Coombs tests, bone marrow smear, arterial blood gas, sputum smear and culture, and high-resolution CT scan of the chest.

Diagnosis. Diffuse alveolar hemorrhage associated with systemic lupus erythematosus.

Management. The patient did not respond to pulsed intravenous methylprednisolone (two courses of 500 mg per day for 3 days) and intravenous immunoglobulin (20 g per day for 5 days). The patient was referred to a specialist treatment center for allogenic transplantation using umbilical-cord-derived mesenchymal stem cells. She underwent transplantation with an infusion of 8 × 107 mesenchymal stem cells. After showing dramatic improvements in her clinical condition, oxygenation level, radiographic and hematological status, the patient was discharged from hospital approximately 5 weeks after undergoing transplantation.

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Figure 1: Chest HRCT scans before and after UC-MSCT.

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Acknowledgements

The authors are grateful to the patient's family for granting permission to write this case report. They thank Dr. Xiang Hu and Shengqin Ye (Jiangsu Stem Cell Bank, Jiangsu, China) for providing the MSCs. They thank Dr. Gary S. Gilkeson (Department of Rheumatology, Medical University of South Carolina, Charleston, SC, USA) for his critical review of the manuscript. This work was supported by grants from the National Natural Science Foundation of China (No. 30772014 and No. 30972736), Jiangsu Province 135 Talent Foundation (RC2007002), Jiangsu Province Natural Science Foundation (No. 09KJB320010), Jiangsu Province Science-Technology Achievement Transforming Foundation (BA2009124), Jiangsu Province “Six Summit Talent” Foundation and Nanjing Health Bureau Young Scientists Launching Project (QYK09174).

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Authors and Affiliations

  1. Department of Rheumatology and Immunology, The Affiliated Drum Tower Hospital of Nanjing University Medical School, 321 Zhongshan Road, Nanjing, 210008, Jiangsu, China

    Jun Liang, Fei Gu, Hong Wang, Bingzhu Hua & Lingyun Sun

  2. Immunology Laboratory, Nanjing University Medical School, 22 Hankou Road, Nanjing, 210093, Jiangsu, China

    Yayi Hou

  3. Center for Craniofacial Molecular Biology, University of Southern California School of Dentistry, 2250 Alcazar Street, CSA 103, Los Angeles, 90033, CA, USA

    Songtao Shi

  4. Department of Pathology and Center of Infection and Immunology, The University of Hong Kong, Pokfulam Road, Hong Kong, China

    Liwei Lu

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  1. Jun Liang
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Correspondence to Lingyun Sun.

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Liang, J., Gu, F., Wang, H. et al. Mesenchymal stem cell transplantation for diffuse alveolar hemorrhage in SLE. Nat Rev Rheumatol 6, 486–489 (2010). https://doi.org/10.1038/nrrheum.2010.80

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