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Case Report
Massive and unilateral rheumatoid pleural effusion without overt disease
1 Department of Medicine, Faculty of Medicine, Kuwait University, Safat, Kuwait
2 Department of Medicine, Nephrology Unit, Amiri Hospital, Ministry of Health, Kuwait, Kuwait
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Kamel El-Reshaid
Professor, Department of Medicine, Faculty of Medicine, Kuwait University, P O Box 24923, 13110 Safat,
Kuwait
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Article ID: 101277Z01KR2021
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El-Reshaid K, Al-Bader S. Massive and unilateral rheumatoid pleural effusion without overt disease. Int J Case Rep Images 2021;12:101277Z01KR2021.ABSTRACT
Introduction: Rheumatoid arthritis (RA) is an autoimmune disease that manifests as a progressive mutilating arthritis with rare systemic involvement. The prevalence of its pleuropulmonary manifestations hardly exceeds 5% of cases. The reported ones include: pleurisy, interstitial fibrosis, effusion, rheumatoid nodules, and Caplan’s syndrome. The latter has been described in association with disease activity or as late complications.
Case Report: We present a patient with progressive and unilateral pleural effusion (PE) due to rheumatoid arthritis (RA) yet without overt systemic manifestations of disease which is exceedingly rare. Diagnosis was suspected by an exudative PE that had low glucose (compared to his serum) and pathognomonic cytology. Subsequently, it was confirmed by high anti-cyclic citrullinated peptide (anti-CCP) antibody. The effusion regressed significantly, 1 month later, after Prednisone and Rituximab therapy.
Conclusion: Rheumatoid arthritis should be considered in patients presenting with exudative PE that lacks history of trauma, and manifestations of infection, malignancy, and autoimmune diseases. High anti-CCP and cytological examination are useful in diagnosis.
Keywords: Lung, Pleural effusion, Rheumatoid arthritis, Rituximab
SUPPORTING INFORMATION
Author Contributions
Kamel El-Reshaid - Conception of the work, Design of the work, Acquisition of data, Analysis of data, Drafting the work, Revising the work critically for important intellectual content, Final approval of the version to be published, Agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.
Shaikha Al-Bader - Conception of the work, Design of the work, Acquisition of data, Analysis of data, Drafting the work, Revising the work critically for important intellectual content, Final approval of the version to be published, Agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.
Guarantor of SubmissionThe corresponding author is the guarantor of submission.
Source of SupportNone
Consent StatementWritten informed consent was obtained from the patient for publication of this article.
Data AvailabilityAll relevant data are within the paper and its Supporting Information files.
Conflict of InterestAuthors declare no conflict of interest.
Copyright© 2021 Kamel El-Reshaid et al. This article is distributed under the terms of Creative Commons Attribution License which permits unrestricted use, distribution and reproduction in any medium provided the original author(s) and original publisher are properly credited. Please see the copyright policy on the journal website for more information.
