The race against death
The 14-year-old girl was treated for systemic lupus red blood disease (SLE) (a chronic autoimmune disease in which the body's immune system mistakenly attacks healthy tissues and organs) at another central hospital and was discharged from the hospital.
Just three days later, the child began to cough red blood continuously, fever of 37.5 - 38 degrees Celsius, then rapidly lost breathing and fatigue. When admitted to the Pediatric Center, Bach Mai Hospital, the child was in critical condition: SpO2 was only 80%, circulatory failure and severe anemia.
Doctor Pham Cong Khac, Pediatric Center, Bach Mai Hospital recalled: The baby was transferred in a state of severe cough, respiratory and circulatory failure, and severe anemia. At that moment, everyone felt terrible pressure, but no one was allowed to doubt.
Faced with the risk of death, the doctors were forced to perform a quick review. We think a lot about the complications of follicular bleeding that spread in lupus patients. This is a rare complication, occurring only in about 2% of children with lupus, but it is very dangerous, progresses quickly and can easily cause death, Dr. Khac recalled.
Consider life and death, decide in a nutshell
The clinical and testing data was urgently analyzed by the team of experts. Children with continuous bleeding caused severe anemia on a strong lupus-basedund, chest CT image showed spread, thickened, blurred vision damage, suitable for dilated cyst bleeding. No signs of blood clotting disorder, negative infection testing...
We cannot wait for bronchial endoscopy to confirm, because every minute that passes is the line of life and death, emphasized Dr. Mai Thanh Cong, Pediatric Center, Bach Mai Hospital.
After an emergency consultation, the doctors decided to give a treatment plan: using methylprednisolone with a high dose combined with cyclophosphamide vein. This is a classic scenario for active lupus cases with life-threatening complications, although the risk of immune inhibitory complications is very high.
miraculous revival
The fifth day after treatment, the emotional moment came to the medical team: the child had no more bleeding coughing, no longer had difficulty breathing, could breathe on his own without the need for a support machine, and had a complete fever cutting.
The child gradually recovered, respiratory and circulatory functions improved significantly. This is the result of a series of urgent, accurate and responsible actions.
According to Dr. Cong, the case was particularly successful thanks to: Early identification of an extremely rare and life-threatening complication, decisive application of a high-dose immunosuppression regimen, close coordination between specialties in the same end-line pediatric center...
In particular, the child patient was discharged from the hospital in a stable condition and continued to be treated as an outpatient.
Dr.BS. Nguyen Thanh Nam - Director of the Pediatric Center, Bach Mai Hospital commented: "This is a typical example of the complexity of lupus in children. Complications of the disease are very rare, with a mortality rate of up to 50%. The success of the case shows that professional capacity, interdisciplinary coordination and decisiveness in treatment are key factors.
