Systemic lupus erythematosus (SLE) is a disorder of unknown etiology characterized by immunologically mediated inflammation affecting multiple organs and the presence of autoantibodies to components of the cell nucleus. The clinical criteria necessary to establish the diagnosis of SLE have been published by the American Rheumatologic Association. Almost any organ system can be affected by the disease. Intrathoracic involvement is among the more serious complications. Thoracic complications occur in more than 50 per cent of patients (Table...!). Morphological changes in pleuropulmonary tissues are non-specific. Many of the histopathological lesions are not caused by SLE itself but by secondary factors, such as congestive cardiac failure, infection, aspiration, and immuno-compromised status. The thoracic complications with the potential to cause critical illness in patients with SLE include pulmonary alveolar hemorrhage, respiratory infections, pericardial effusion, lupus pneumonitis, pulmonary thromboembolism, pulmonary hypertension, and massive pleural effusion. Other complications, such as interstitial pneumonitis and fibrosis and diaphragmatic weakness, are seldom severe enough to produce respiratory failure. An important clinical 'pearl' is to recognize that almost all the serious thoracic complications occur in the acute (active) phase of SLE; indeed, a thoracic complication may be the presenting manifestation of the disease.
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