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A6681 - An Unusual Cause of Pleural Effusion
Author Block: I. Kejo1, J. Salonia2, A. Diaz3, D. Pan4, M. M. O'Sullivan4; 1Medicine, Icahn school of medicine at Mount Sinai St. Luke's and Mount Sinai West, New York, NY, United States, 2Pulmonary and Critical Care, Icahn school of medicine at Mount Sinai St. Luke's and Mount Sinai West, New York, NY, United States, 3Medicine, Icahn school of medicine at Mount Sinai St. Luke's and Mount Sinai West, new york, NY, United States, 4Icahn school of medicine at Mount Sinai St. Luke's and Mount Sinai West, New York, NY, United States.
Introduction: Pulmonary involvement is common in Sjögren syndrome. However pleural effusion is uncommon. Here we report a case of 41-year-old AA male who presented with pleural effusion and was found to have primary Sjogren's syndrome. Case presentation: 41-year-old AA male was admitted for evaluation of two weeks of cough, was found to have new right pleural effusion on chest X-ray. Pleural fluid analysis showed colorless fluid, WBC 140 /UL, Lymphocytes 92%, RBC 1750 /UL, PH 7.7, LDH 536 U/L (serum LDH 515 U/L ), protein 5.4 g/dl (serum protein 7.1 g/dl), glucose 88 mg/dl ( serum glucose 110mg/dl ), ADA 5.9 U/L ( normal range 0.0-9.4 U/L ). Three sputum samples were negative for AFB and QuantiFERON-TB Gold was negative. CT angio chest was obtained, and showed no PE but new development of small pericardial effusion. TTE showed a small pericardial effusion. Rheumatologic work up started and showed ANA strongly positive (1/2560) and elevated ESR to 80 mm/hr,C3/C4 levels were normal, ds DNA IgG was normal, RF 20 ( 0-15) but Anti-CCP negative, SSA 60 ( Ro) 121 AU/ml ( 0-40 U/ml ), SSA 52 (Ro) 172 AU/ml (0-40 ), smith Ab negative, ribnucleic protein 0 AU/ml ( 0-40 ). PFTs consistent with mild restrictive process with moderate reduction in DLCO. Ophthalmology evaluation obtained and showed decreased Tear break-up time (TUBT). Rheumatology consulted and a diagnosis of primary Sjogren syndrome was made based on the American-European Consensus Sjögren’s Classification Criteria. Discussion: The reported prevalence of Sjogren's syndrome ranges from 0.5% to 3%. Lung manifestations include diffuse lung disease and tracheobronchial disease (1). The disease is rarely accompanied by serositis such as pleuritis or pericarditis. During our search in the literature we have found only nine reports of primary Sjogren’s syndrome complicated by pleural effusion, most of these cases reported in Asians, this is the first case to be reported in an African American. Though pleuristy and pleural effusion is rare in primary Sjogren syndrome it should be considered as it has been described before. Further studies are required to establish the incidence between Sjogren's syndrome and pleural effusion. References : (1) Gardiner P, Ward C, Allison A, Ashcroft T, Simpson W, Walters H, Kelly C. : Pleuropulmonary abnormalities in primary Sjögren's syndrome. J Rheumatol 1993; 20: pp. 831-837