1/40. pleural effusion during interferon treatment for chronic hepatitis c.A 54-year-old male patient was admitted to Osaka University Medical School Hospital for interferon treatment for chronic hepatitis c and the daily administration of recombinant interferon-alpha 2a started at the dose of 9 megaunits per day. Fourteen days later, moderate right pleural effusion was detected by abdominal magnetic resonance imaging study. He had experienced no symptom to suggest pleural effusion or any pulmonary lesions during interferon treatment. The pleural fluid was serous, showing the character of slightly bloody, turbid and positive Rivalta test, and the levels of lactic dehydrogenase and adenosine deaminase were not elevated. His serum titer of anti-nuclear antibody increased to 80 in homogenous staining, but anti-dna antibody and anti-liver kidney microsome-1 antibody remained negative. Other laboratory tests or physical findings could not satisfy the criteria of any autoimmune diseases, such as systemic lupus erythematosus. After discontinuation of interferon administration, his pleural effusion resolved gradually and disappeared completely by use of no specific drugs. This is the first case that pleural effusion developed during interferon administration without any other clinical signs indicating autoimmune diseases. The increase of serum titer of anti-nuclear antibody prompted us to elucidate that pleuritis might be induced by immunological activation of interferon.- - - - - - - - - - ranking = 1keywords = lupus erythematosus, erythematosus, systemic lupus erythematosus, lupus, systemic lupus (Clic here for more details about this article) |
2/40. Lupus-like syndrome with submassive hepatic necrosis associated with hepatitis a.hepatitis a is a common self-limited liver disease. However, 15% of patients may have some complications. Autoimmune hepatitis that is triggered by viral hepatitis has been reported. We hereby describe an unrecognized association of hepatitis a with a full blown lupus-like syndrome manifested by the appearance of arthralgia, exudative pleural effusion with the presence of lupus erythematosus cells and autoantibodies. All these findings disappeared after a short course of steroid treatment. The case is presented and the literature is reviewed.- - - - - - - - - - ranking = 0.92053900454099keywords = lupus erythematosus, erythematosus, lupus (Clic here for more details about this article) |
3/40. Systemic lupus erythematosus associated with massive ascites and pleural effusion in a patient who presented with disseminated intravascular coagulation.A case of systemic lupus erythematosus (SLE) associated with serositis presenting with disseminated intravascular coagulation (DIC) is reported. A 53-year-old woman was admitted because of a fever. Laboratory tests revealed increased plasma levels of fibrinogen degradation products (FDP) and FDP-D-dimer, high titers of anti-nuclear antibody, high serum levels of anti-dna antibody, immune complexes, decreased serum complements, and persistent proteinuria. A CT scan showed massive ascites and pleural effusion, marked edema and swelling of the mesenterium. The patient's condition and immunological abnormalities improved after steroid therapy. The association of DIC and lupus serositis has never been described in the literature.- - - - - - - - - - ranking = 4.5343407717967keywords = lupus erythematosus, erythematosus, systemic lupus erythematosus, lupus, systemic lupus (Clic here for more details about this article) |
4/40. Drug-induced lupus erythematosus by amiodarone.We report a case with typical clinical features of drug-induced lupus erythematosus, together with verrucous endocarditis and pleuropericardial effusion, due to amiodarone treatment. After cessation of amiodarone treatment, the patient recovered completely.- - - - - - - - - - ranking = 4.3563362787595keywords = lupus erythematosus, erythematosus, lupus (Clic here for more details about this article) |
5/40. Fibrothorax and severe lung restriction secondary to lupus pleuritis and its successful treatment by pleurectomy.Pleural disease is a common pulmonary manifestation of systemic lupus erythematosus (SLE) that usually responds to corticosteroids and other immunosuppressive agents. In the present report, a new approach, pleural decortication, was used in a patient with medically refractory chronic pleuritis secondary to severe SLE. A 26-year-old woman with known SLE developed progressive dyspnea and pleuritic chest pain over several months. The other systemic manifestations of her lupus were controlled with cyclophosphamide and prednisone. A computed tomography scan revealed a persistent, small, loculated right pleural effusion; pleural thickening; and atelectasis of the right middle and lower lobes. Pulmonary function tests showed a severe restrictive defect. The patient was disabled by her severe dyspnea despite maximal medical therapy, and, therefore, surgery was considered. A right thoracotomy revealed entrapment of the right lung by dense visceral pleura. Decortication was performed. On pathology, pleuritis with vascular pleural adhesions was found. No lupus pneumonitis was noted. Postoperatively, a significant clinical improvement in dyspnea was evident within several weeks. On a 6 min walk test, the patient achieved 384 m with a Borg dyspnea scale rating of 2 compared with 220 m and a Borg dyspnea scale rating of 4 preoperatively. Her forced vital capacity improved from 24% predicted to 47% predicted, and her total lung capacity improved from 35% predicted to 54% predicted. Medical therapy of systemic lupus erythematosus has been proven to be effective in controlling pleuritis in most cases. However, in the event of refractory pleuritis or pleural thickening, decortication may be a viable alternative.- - - - - - - - - - ranking = 2.2956304927345keywords = lupus erythematosus, erythematosus, systemic lupus erythematosus, lupus, systemic lupus (Clic here for more details about this article) |
6/40. Massive bilateral pleural effusion as the only first presentation of systemic lupus erythematosus.A rare case of systemic lupus erythematosus (SLE), with massive bilateral pleural effusions as the first manifestation, is described. The patient was a previously healthy 20-year-old soldier. Initial investigations were unrevealing, but after 3 months the patient developed the full-blown syndrome. He responded well to corticosteroids and cyclophosphamide with resolution of the pleural effusions and improvement of the clinical picture. SLE should always be considered in cases of massive pleural effusions, even in the absence of other overt stigmata of the disease.- - - - - - - - - - ranking = 5keywords = lupus erythematosus, erythematosus, systemic lupus erythematosus, lupus, systemic lupus (Clic here for more details about this article) |
7/40. Antinuclear antibody positive pleural effusion in a patient with tuberculosis.A patient with tuberculosis presented with a pleural effusion that was highly positive for antinuclear antibody (ANA). The pleural fluid autoimmune profile was positive for ANA IgG at a titre of 1 : 1280. Antibodies to double-stranded dna were not detected in the pleural fluid or in serum.The serum autoimmune profile was positive for ANA IgG at 1 : 160 and IgM at 1 : 40. Pleural fluid was positive on culture for mycobacterium tuberculosis after 8 weeks. Pleural biopsy for histology showed chronic inflammation and culture revealed no growth. The pleural fluid resolved with the anti-tuberculous treatment, and signs and symptoms of systemic lupus erythematosus or malignancy did not occur, which suggests that tuberculous pleural effusion is one of the causes of high ANA in pleural fluid.- - - - - - - - - - ranking = 1keywords = lupus erythematosus, erythematosus, systemic lupus erythematosus, lupus, systemic lupus (Clic here for more details about this article) |
8/40. Immune complex vasculitis as a cause of ascites and pleural effusions in systemic lupus erythematosus.A patient is described with systemic lupus erythematosus and large painless ascites and pleural effusions. Pleural and peritoneal fluid complement levels were depressed, and dna binding was elevated in the presence of normal serum values. Immunoglobulin and complement deposits were demonstrated in vessels of the pleura, peritoneum, and skin, along with histologic evidence of vasculitis. The relation of the ascites and pleural effusions to the presence of widespread vasculitis and local immune complex formation is discussed. These complications responded poorly to corticosteroid therapy but slowly resolved following the addition of an immunosuppressive agent.- - - - - - - - - - ranking = 5keywords = lupus erythematosus, erythematosus, systemic lupus erythematosus, lupus, systemic lupus (Clic here for more details about this article) |
9/40. Therapeutic options for refractory massive pleural effusion in systemic lupus erythematosus: a case study and review of the literature.OBJECTIVES: Massive refractory pleural effusions are uncommon in patients with systemic lupus erythematosus. Describing such a patient, the literature was reviewed to report the various therapeutic options in such cases. methods: medline search using the terms "lupus" and "pleural effusion," inclusion of cases with refractory massive effusions with emphasis on treatment. RESULTS: Only 10 such cases (including the patient described here) were reported in the English literature over the past 25 years. Those 10 patients suffered symptoms related to pleural effusion for a long period of time until resolution, ranging between 2 months to 2.5 years (median 6 months). During that period of time they underwent multiple fluid aspirations. Seven different types of therapy were reported in these case descriptions. They can be divided into 2 major groups: systemic therapy (immunosuppressive therapy, plasmapheresis, and intravenous immunoglobulin) and local therapy (intrapleural steroid injections, pleurodesis with talc or tetracycline, and pleurectomy). pleurodesis with talc seemed to be the most effective treatment modality. CONCLUSIONS: Due to the small number of reported patients, the best type of intervention is uncertain. When refractory pleural effusion is part of lupus exacerbation, the treatment of choice would be systemic, such as immunosuppressive therapy with high-dose steroids and cyclophosphamide. Intravenous immunoglobulin may also be considered. Local measures such as talc pleurodesis should be employed if systemic measures fail, or when pleural effusion is the only manifestation of lupus.- - - - - - - - - - ranking = 5.1478152463673keywords = lupus erythematosus, erythematosus, systemic lupus erythematosus, lupus, systemic lupus (Clic here for more details about this article) |
10/40. Systemic lupus erythematosus presenting with recurrent pleural effusion without any systemic manifestation.pleural effusion can be the sole presenting manifestation in about 5 percent of cases with SLE. We are reporting a case of SLE which presented with recurrent pelural effusion without other systemic manifestation.- - - - - - - - - - ranking = 3.4850690230076keywords = lupus erythematosus, erythematosus, lupus (Clic here for more details about this article) |
| | Next -> |