Refractory Pleural Effusion in Systemic Lupus Erythematosus Treated by Pleurectomy

Sichan Kim; Han-bit Park; Yun Kyung Cho; Sangyoung Yi; Kyunghwan Oh; Dong Kwan Kim; Bin Yoo

doi:10.4078/jrd.2017.24.1.43

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Kim, Park, Cho, Yi, Oh, Kim, and Yoo: Refractory Pleural Effusion in Systemic Lupus Erythematosus Treated by Pleurectomy

Case Report

J Rheum Dis 2017;24(1):43-47.

Published online: 31 October 2017

DOI: https://doi.org/10.4078/jrd.2017.24.1.43

Refractory Pleural Effusion in Systemic Lupus Erythematosus Treated by Pleurectomy

Sichan Kim¹, Han-bit Park¹, Yun Kyung Cho¹, Sangyoung Yi¹, Kyunghwan Oh¹, Dong Kwan Kim², Bin Yoo¹

¹Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea

²Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea

Corresponding to: Bin Yoo, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul 05505, Korea. E-mail: byoo@amc.seoul.kr

Received 6 July 2016 Revised 28 July 2016 Accepted 8 August 2016

This is a Open Access article, which permits unrestricted non-commerical use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Pleural effusion is a common pulmonary manifestation of systemic lupus erythematosus (SLE) and often occurs as bilateral exu-dative pleural effusion. The condition usually responds quickly to corticosteroid therapy. However, massive pleural effusion refractory to immunosuppressive drugs has rarely been reported; thus, the proper therapeutic modality is largely decided on a case-by-case basis. In this case, we describe successful treatment with surgical pleurectomy for massive refractory pleural effusion in a patient with SLE.

Keywords: Systemic lupus erythematosus, Pleural effusion, Fibrothorax, Pleurectomy

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Figure 1.

Chest X-ray showing bilateral pleural effusion.

Figure 2.

Chest X-ray showing persistent bilateral pleural effusion after pleurodesis of right pleura and rituximab administration.

Figure 3.

Chest computed tomography showing bilateral pleural effusion with multilo-culated effusion in both hemi-thoraces.

Figure 4.

Chest X-ray showing remaining bilateral cardio-phrenic angle blunting but a decreased amount of both pleural effusions after pleurectomy.

Figure 5.

Drug history and systemic lupus erythematosus (SLE) disease activity index-2K score. HCQ: hydroxychloroquine, MMF: mycophenolate mofetil, SLEDAI-2K: SLE disease activity index-2K.

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