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Pulmonary hemorrhage in lupus erythematosus without evidence of an immunologic cause.

To the Editor. —We have read with great interest the article by Desnoyers et al 1 in the July 1984 issue of the Archives referring to a case of pulmonary hemorrhage (PH) in systemic lupus erythematosus (SLE). Although we consider that the case reported is most interesting, we disagree with these authors on several points. We herein discuss a similar patient whom we have studied recently. 2 In our case, the patient died as a consequence of two episodes of massive PH. We think that the patient described by Desnoyers et al probably also had two episodes of PH and that the first episode went unnoticed because it was attributed to a mycoplasmal pneumonia and because the anemia was presumed to be due to gastrointestinal tract bleeding. We believe that a guaiac-positive stool is not sufficient evidence to account for such severe gastrointestinal tract bleeding. Otherwise, hemolytic anemia associated with