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).