Lupus Pleuritis: Clinical Features and Pleural Fluid Characteristics with Special Reference to Pleural Fluid Antinuclear Antibodies

doi:10.1378/chest.84.6.714

Chest

Volume 84, Issue 6, December 1983, Pages 714-718

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Eighteen patients with lupus erythematosus (LE) and pleural effusions were evaluated. Fourteen patients had lupus pleuritis and four had pleural effusions of other etiologies. All patients were symptomatic, and the presenting signs and symptoms did not help distinguish between lupus pleuritis and pleural effusions of other causes. The presence of LE cells confirmed the diagnosis of lupus pleuritis in seven of eight patients. In 11 of 13 patients with lupus pleuritis, the pleural fluid antinuclear antibody (ANA) titer was ≥1:160, and in nine of 13 patients with lupus pleuritis, the pleural fluid to serum (PF/S) ANA ratio was ≥1. In the four patients with LE and a pleural effusion of another etiology, the pleural fluid ANA titer was negative in two and low titer in two (1:40, 1:80); the pleural fluid to serum ANA titer was always less than one. Of 67 patients with pleural effusions of other etiologies, the pleural fluid ANA was negative. The signs and symptoms of lupus pleuritis are nonspecific, however; the findings of LE cells in pleural fluid confirms the diagnosis and a high pleural fluid ANA titer (≥1:160) and a PF/S ANA ratio of ≥1 strongly supports the diagnosis.

Section snippets

METHODS

Eighteen patients with lupus erythematosus and pleural effusions were evaluated at the University of Colorado Health Sciences Center and affiliated hospitals from January 1979 to June 1982. All patients had the clinical diagnosis of systemic lupus erythematosus based on having four or more of the American Rheumatism Association criteria for the diagnosis of lupus.³

In 14 patients, lupus was thought to be responsible for the pleural effusion and in four patients other etiologies were established.

RESULTS

Table 1 reviews the presenting signs and symptoms and pleural fluid characteristics on admission of the 14 patients with lupus pleuritis. In five of these patients, the diagnosis was initially suspected. The most common presenting symptoms in these patients were pleuritic pain and dyspnea. No patients had hemoptysis. Evidence of pleural effusion on physical examination was present in 12 of 14 patients. All patients with lupus pleuritis were symptomatic at the time of presentation and most had

DISCUSSION

While the pleuropulmonary manifestations of systemic lupus occur commonly, lupus pleuritis initially may be overlooked as the cause of the pleural effusion. First, SLE may not have been diagnosed previously. Second, the presentation is nonspecific and compatible with other diagnoses. In the 14 patients with lupus pleuritis, only five had this admitting diagnosis, while the remainder had initial diagnoses of pulmonary embolism, empyema, tuberculous pleurisy, congestive heart failure, and

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Assistant Professor of Medicine.

Professor of Medicine.

Manuscript received February 28; revision accepted June 17.

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Lupus Pleuritis: Clinical Features and Pleural Fluid Characteristics with Special Reference to Pleural Fluid Antinuclear Antibodies

Section snippets

METHODS

RESULTS

DISCUSSION

Chest

Chest

J Allerg Clin Immunol

Clin Immunol Immunopathol

Chest

On the visceral manifestations of erythema group of skin diseases

Am J Med

Primer on the rheumatic diseases

JAMA

Laboratory tests for antinuclear antibody in rheumatic disease

Lab Med

Pleural fluid glucose in systemic lupus erythematosus

Mayo Clinic Proc

Native and drug-induced lupus pleuritis: a cause of low glucose-low pH pleural effusion

Chest