Therapeutic options for refractory massive pleural effusion in systemic lupus erythematosus: A case study and review of the literature
Section snippets
Methods
We describe a patient with recurrent massive pleural effusion, refractory to therapy with high-dose steroids and AZA. The English literature of the last 25 years was reviewed using a MEDLINE search with the terms “lupus” and “pleural effusion.” Cases with refractory (ie, not responsive to steroid therapy) massive effusions were included. The various therapeutic options in cases with recurrent massive pleural effusions refractory to steroid therapy are described in detail.
Report of a case
A 25-year-old woman with SLE was admitted with shortness of breath, gradually increasing in severity over the past few weeks. She had intermittent pleuritic-type left-sided chest pain. She was diagnosed with SLE 3 years previously, presenting with arthritis in the proximal interphalangeal (PIP) joints, knees, and ankles, skin rash on her face and extremities, severe myalgia, and fever. At that time, her ANA test (Euroimmune AG, Germany) was positive with a titer of 1:640, anti-dsDNA was
Discussion
This patient represents an uncommon scenario of SLE-related pleuritis associated with large pleural effusion, refractory to “first-line” immunosuppressive therapy with prednisone and AZA. Reviewing the English-language literature of the past 25 years, we found detailed descriptions of only 7 similar cases (8, 9, 10, 11, 12, 13, 14, 15) and a limited description of 2 other cases (16). All 10 cases are summarized in Table 1. The paucity of cases suggests that this phenomenon of refractory massive
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Pulmonary manifestations of systemic lupus erythematosus
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2018, Dubois' Lupus Erythematosus and Related SyndromesClinical Features of Systemic Lupus Erythematosus
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2013, Autoimmunity ReviewsCitation Excerpt :Only three cohort studies (2 × pulmonary hemorrhage and 1 × serositis) were found with respectively 34, 22 and 37 patients [102,112,113]. Besides, several case reports or case series have been published on pulmonary manifestations and shrinking lung disease [114–121]. In all patients with pulmonary hemorrhages, iv pulse therapy was given followed by 40 mg prednisone/day up to 3 mg/kg/day orally.
Clinical Features of Systemic Lupus Erythematosus
2012, Kelley's Textbook of Rheumatology: Volume 1-2, Ninth EditionMassive pleural effusion in systemic lupus erythematosus
2009, Reumatologia Clinica
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