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Volume 46, Number 2, April 2013

Systemic lupus erythematosus with initial presentation of empyematous pleural effusion in an elderly male patient: A diagnostic challenge 


Wei-Ting Chang, Tung-Han Hsieh,*, Ming-Fei Liu


Received: September 6, 2011    Revised: October 13, 2011    Accepted: November 17, 2011   

 

Corresponding author:

Corresponding author. Department of Internal Medicine,
National Cheng Kung University College of Medicine and Hospital,
Number 138, Sheng Li Road, East District, Tainan City, Taiwan 704,
ROC.
E-mail address: mevalotin2000@yahoo.com.tw (T.-H. Hsieh). 



 

Background and purpose: 

Systemic lupus erythematosus (SLE) poses great difficulty in making an early diagnosis in elderly males, often presenting with atypical manifestations. Acute onset of empyematous pleural effusion has rarely been seen. Herein, we report a 66-year-old man with SLE presenting with rapid progression of bilateral pleural effusion. Diagnostic thoracocentesis disclosed neutrophil-predominant exudates and chest computed tomography revealed multiple loculated pleural effusions. Nevertheless, optimal antibiotic therapy plus surgical decortication of the pleura did not improve his condition. The diagnosis of SLE was readily established after LE cells were accidentally found in the pleural effusion. Large amounts of pleural effusion subsided soon after high dose corticosteroid therapy. 



 

Key words:

Elderly male, LE cell, Pleural effusion, Systemic lupus erythematous