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Successful treatment of recurrent pleural and pericardial effusions with tocilizumab in a patient with systemic lupus erythematous
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Successful treatment of recurrent pleural and pericardial effusions with tocilizumab in a patient with systemic lupus erythematous
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Successful treatment of recurrent pleural and pericardial effusions with tocilizumab in a patient with systemic lupus erythematous
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Journal Article
Successful treatment of recurrent pleural and pericardial effusions with tocilizumab in a patient with systemic lupus erythematous
2016
Overview
A 22-year-old Caucasian man presented to hospital with pleuritic chest pain. He had had a history of a sun-sensitive rash a year prior. Workup revealed normal cardiac enzymes and chest X-ray. However, electrocardiogram revealed ST elevation and PR depression, and echocardiogram revealed a slight pericardial effusion without other findings. A diagnosis of pericarditis was made. Subsequently, he was found to be positive for antinuclear antibodies (ANAs), as well as antibodies to SSA, SSB and double-stranded DNA; C3 was low, and C4 was undetectable. A diagnosis of systemic lupus erythematosus was made. The patient initially responded to high-dose ibuprofen. One month later, he developed a new pericardial effusion, this time with concomitant massive left-sided pleural effusion, requiring three separate thoracenteses draining a total of 6 L of pleural fluid. The recurrent effusion failed to respond to high-dose corticosteroid treatment. Owing to the severity and rapidity of the recurrence of pleural and pericardial effusion, intravenous tocilizumab was administered. The patient had excellent clinical and radiographic improvement. This case shows that tocilizumab may have a role in the treatment of intractable pleuropericardial effusion and other forms of lupus-associated serositis.
Publisher
BMJ Publishing Group Ltd,BMJ Publishing Group LTD,BMJ Publishing Group
Subject
/ Antibodies, Monoclonal, Humanized - therapeutic use
/ Enzymes
/ Humans
/ Lupus
/ Lupus Erythematosus, Systemic - complications
/ Male
/ Novel treatment (new drug/intervention; established drug/procedure in new situation)
/ Pain
/ Patients
/ Pericardial Effusion - etiology
/ Pericardial Effusion - therapy
/ Steroids
/ White
