Table 2: Case reports of massive pleural
effusions as the presenting feature of SLE.
Year/Author |
Clinical Presentation |
Pleural fluid WBC |
ANA |
anti-dsDNA |
C3 |
C4 |
Treatment |
Outcome |
Bouros [3] |
20yo M with dyspnea and fevers ×1 week |
500 × 106 cells/L; 70%
lymphocytes |
1:350 |
pos |
17.5 mg/dL |
3.52 mg/dL |
methylprednisolone 64 mg/day × 2 months then
slowly tapered; cyclophosphamide 150 mg/day × 6 months, then 100 mg/day × 6 months |
effusion resolved by
20 days, minimal pleural thickening remained |
Mitra [12] |
20yo F with dyspnea × 7
days |
200-1970 × 106 cells/L; 20-40% lymphocytes,
60-80% neutrophils |
1:160 |
98 ng/dL |
NR |
NR |
prednisolone 1 mg/kg/day, maintained on
chronic steroids |
near complete
resolution of pleural effusion at 4 weeks |
Wan [5] |
23yo F with cough and
chest pain x1 week |
NR |
320X |
1:620 |
35.5 mg/dL |
< 10 mg/dL |
prednisolone 2 mg/kg/day; methotrexate 7.5 mg/wk - subsequently maintained on
prednisolone 10 mg/day |
effusion decreased
dramatically by 1 month |
Chang [17] |
66yo M with fever and
dyspnea × 1-2 weeks despite levoquin for pneumonia. |
340-2950 × 106 cells/L ; 3-16% lymphocytes and 48-92% neutrophils |
1:1280 |
1:160 |
dcr |
dcr |
methylprednisolone 1 mg/kg/day |
complete resolution
of pleural effusion and symptoms |
YO:
Year Old; M:
Male; F: Female; NR: Not Reported; Pos: Positive;
DCR: Decreased Serum Complement Levels (taken from the original publication, actual serum
level not reported).