scholarly journals RHEUMATOID ARTHRITIS 1ST TIME PRESENTING WITH BILATERAL PLEURAL EFFUSION- A RARE PRESENTATION

2019 ◽  
Vol 05 (05) ◽  
pp. 404-406
Author(s):  
Sayan Malakar ◽  
Kailash Nath Sharma ◽  
Abhinav Rana ◽  
Tarun Sharma
2014 ◽  
Vol 8 (1) ◽  
pp. 14-17
Author(s):  
Ayse Baccioglu ◽  
Fusun Kalpaklioglu ◽  
Omur Gungor ◽  
Dilay Cimen

Blood ◽  
2005 ◽  
Vol 106 (11) ◽  
pp. 5100-5100
Author(s):  
Aref Agheli ◽  
Alka Arora ◽  
Maged Khalil ◽  
Theresa Dumlao ◽  
Seema Naik ◽  
...  

Abstract Pulmonary arterial hypertension secondary to vascular deposition is a rare presentation of Primary Amyloidosis. The natural history of pulmonary hypertension and concomitant right-sided cardiac failure is not very well understood and is associated with a very short median survival. This syndrome is a marker of advanced Amyloidosis Persistent pleural effusion is another much rarer presentation of pulmonary involvement in Primary Amyloidosis and is secondary to pleural infiltration, which sometimes is difficult to distinguish from the cardiomyopathic causes. The incidence of pleural effusion in primary Amyloidosis is 1–2%. This syndrome also has a very poor prognosis, and has limited response to treatment, however, pleurodesis has been temporarily useful in some cases. Case report: A 74 year old African American female, non-smoker, with history of hypertension, who presented with shortness of breath and persistent productive cough and 18 pounds weight loss for the last six months. The initial chest x-rays showed bilateral pleural effusion and a transudate fluid on analysis. Cardiac workup for an atypical chest pain revealed moderate to severe pulmonary hypertension without myocardial infiltration on 2-D echocardiogram, and normal coronary arteries on cardiac catheterization. Extensive workup did not show any secondary cause of pulmonary hypertension, however, the patient gradually developed nephrotic range proteinuria and kidney biopsy showed infiltration of 10 nm fibrils, involving 3+ segmental mesangium, and 2+ segmental glomerular basement membranes. This was consistent with renal Primary Amyloidosis, AL Lambda type. A random urine and serum sample for immunofixation also revealed an M- spike of 23 mg/dl in gamma region. A concomitant bone marrow biopsy revealed presence of monoclonal IgG lambda plasma cell (CD38 bright) population, without any B-cell or T-cell markers. Conclusion: Pulmonary hypertension and pleural effusion are two rare and lethal presentations of pulmonary involvements in Primary Amyloidosis, and it should be considered in the differential diagnosis of any patient presenting with pulmonary symptoms. There is no definite treatment of these syndromes, although combinations of steroids and melphalan, along with colchicines, vincristine, adriamycin, and thalidomide have been used with minimum satisfactory outcomes. Autologous stem cell transplantation (SCT) provides the opportunity to give higher doses of chemotherapy and may be of benefit in some cases.


2018 ◽  
Vol 2018 ◽  
pp. 1-4
Author(s):  
Raquel Rosa ◽  
Dionísio Maia ◽  
Nídia Caires ◽  
Rita Gerardo ◽  
Inês Gonçalves ◽  
...  

Pleural involvement is the most frequent thoracic complication of rheumatoid arthritis (RA), usually occurring in patients with known RA. Typical rheumatoid pleural effusion is an exudate characterized by low pH and glucose levels and high LDH activity. Rarely, it has features of pseudochylothorax. Other uncommon complications are pneumothorax, hydropneumothorax, empyema, and bronchopleural fistula. The case of a 51-year-old man with a spontaneous, small, and asymptomatic hydropneumothorax with features of pseudochylothorax is presented. After careful clinical and laboratory evaluation, he was diagnosed with rheumatoid arthritis, and we admitted that the pleural changes were secondary to the connective tissue disease. He started immunosuppressive treatment and maintained stability during follow-up, without need of specific pleural treatment. We hypothesized that the pleural nodule found on the chest computed tomography scan was related with the simultaneous occurrence of pleural effusion and pneumothorax. This is a rare presentation and complication of RA, highlighting the utility of a comprehensive clinical and laboratory evaluation and focusing on the importance of pleural rheumatoid nodules in the pathogenesis of RA pleural disease.


2020 ◽  
Vol 50 (8) ◽  
pp. 938-944
Author(s):  
Ofer Levy ◽  
Daniel Fux ◽  
Tetiana Bartsikhovsky ◽  
Sergei Vosko ◽  
Moshe Tishler ◽  
...  

2019 ◽  
Vol 12 (10) ◽  
pp. e231899
Author(s):  
Yinglun Wu ◽  
Philip C Dittmar

Rheumatoid arthritis (RA) is a common connective tissue disorder affecting the synovial joints. In patients with RA, involvement of the lungs occurs in 30%–40% of cases while pleural effusions occur in only 3%–5%. However, the majority of RA-associated pleural effusions are small, unilateral and asymptomatic. We present a case of massive bilateral pleural effusions in a patient with established rheumatoid pneumoconiosis (Caplan syndrome). Interestingly, the pleural effusion occurred following recent treatment for minimal change disease and atrial fibrillation.


2011 ◽  
Vol 2 (3) ◽  
pp. 128-130 ◽  
Author(s):  
Mohammad Shameem ◽  
Jamal Akhtar ◽  
Nafees Ahmad Khan ◽  
Ummul Baneen ◽  
Rakesh Bhargava ◽  
...  

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