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The combination therapy with extracorporeal membrane oxygenation,
plasmapheresis and continuous renal replacement therapy for massive
diffuse alveolar hemorrhage in a child with systemic lupus erythematosus

Diffuse alveolar hemorrhage (DAH) is a rare and life-threatening complication in children with systemic lupus erythematosus(SLE). Despite recent advances in medical therapy, DAH could drive into catastrophic respiratory failure and hemodynamicunstability. The authors present a case of a 9-year-old girl with lupus nephritis who had rapidly aggravating dyspnea andmassive pulmonary hemorrhage. She was diagnosed as having DAH with acute respiratory distress syndrome and wassuccessfully managed with combined treatment of venovenous extracorporeal membrane oxygenation (ECMO), plasmapheresis,and continuous renal replacement therapy (CRRT). We propose to introduce ECMO and plasmapheresisas early as possible as arescue therapy in children with SLE complicated to DAH, who are irresponsive to conventional treatment.