Pleural effusion as manifestation of temporal arteritis.

Abstract

A previously fit 71 year old woman was admitted to hospital with a one month history of temporal headache, fatigue, and jaw claudication. A few days later she developed right pleuritic chest pain and a productive cough. On examination she had bilateral temporal artery thickening, though the pulses were preserved, and signs ofa right pleural effusion. Laboratory findings included a haemoglobin concentration of 9 9 g/dl, a white cell count of 15 x 109/l (86% neutrophils, 11% lymphocytes, and 3% monocytes), a platelet count of 69 x 109/1, and an erythrocyte sedimentation rate of 126 mm in the first hour. Tests for antinuclear antibodies and rheumatoid factor gave negative results. The chest radiographs showed loss of the costophrenic angle and thickening of the oblique fissure on the right. Abdominal ultrasound examination showed no abnormality. Thoracocentesis yielded serous fluid that showed no specific features on microbiological or cytological examination. The pleural fluid white cell count was 3-2 x 109/1 (45% neutrophils, 5% lymphocytes, 8% hystiocytes, and 42% mesothelial cells); tests for antinuclear antibodies and rheumatoid factor gave negative results. Other laboratory data are shown in the table. A temporal artery biopsy specimen showed histological changes compatible with giant cell arteritis.Treatment with prednisone (1 mg/kg a day) was started and caused rapid symptomatic and radiological improvement. She was still taking prednisone (10 mg/day) and was symptom free when last seen 18 months later.

The Art of Pleural Fluid Analysis

“…190 A PE may also be present in druginduced lupus, but typically resolves after drug withdrawal. [191][192][193][194][195][196][197][198][199][200][201][202] In systemic diseases, the PE may be produced by direct infiltration of the pleura, by an immune mechanism, by renal or cardiac involvement that can accompany these conditions, as well as by the presence of a thromboembolic disease or by drugs. 180 The rest of the systemic diseases in which a PE may be present, 146 as well as their principal characteristics, are summarized in Table 19.…”

Simultaneous Pleural and Pericardial Effusion as First Clinical Manifestations of Giant Cell Arteritis: A Case Report

“…They both had typical symptoms of the disease such a headache, fatigue, and jaw claudication. Their pleural fluid was an exudate that responded to treatment with prednisolone [ 5 ]. Karachalios et al described a case of a 73-year-old woman with temporal headache, low-grade fever, fatigue, pleural pain and a left pleural effusion, in whom the diagnosis of temporal arteritis was made with complete recovery after the initiation of corticosteroids [ 6 ].…”

Unusual manifestations of giant cell arteritis: pulmonary nodules, cough, conjunctivitis and otitis with deafness

“…However, the disappearance of the pulmonary nodules with corticosteroid therapy was an argument against other causes (metastases and infection). Pleural effusions are also rare in GCA, nine reports having been published in the literature, the histological studies of the pleura were nonspecific [6].…”