Markedly elevated cytokines in pleural effusion during the ovarian hyperstimulation syndrome: transudate or ascites?
OBJECTIVE
To study levels of proinflammatory cytokines in pleural fluid during the severe ovarian hyperstimulation syndrome (OHSS).


METHODS
Case report.


METHODS
Tertiary academic medical center.


METHODS
A 35-year-old female with a 6-year history of unexplained infertility on menotropin therapy and 28 healthy normal controls.


METHODS
Thoracentesis for severe pleural effusion and venipunctures.


METHODS
Interleukin-1 beta (IL-beta), interleukin-6 (IL-6), and tumor necrosis factor-alpha (TNF-alpha) levels were measured by ELISA and compared between pleural effusion and serum from normal controls.


RESULTS
Pleural effusion IL-1 beta and IL-6 levels were higher than serum. Interleukin-6 levels were elevated particularly in pleural effusion (1,961.89 pg/mL) compared with serum (3.9 +/- 0.41 pg/mL).


CONCLUSIONS
Our results confirm the high cytokine levels observed in OHSS. Cytokines have been implicated in capillary permeability, extravasation of fluid, oliguria, and shock. We have postulated that these mediators are released from the corpora lutea into the peritoneum and systemic circulation. Alternatively, the presence of high cytokine levels in pleural fluid maybe the result of diaphragmatic defects, which allow for the migration of ascites into the pleural space.
Loret de Mola
J R
JR
Department of Obstetrics and Gynecology, University of Pennsylvania, Philadelphia, USA.
Arredondo-Soberon
F
F
Randle
C P
CP
Tureck
R T
RT
Friedlander
M A
MA
D000328:Adult; D001202:Ascitic Fluid / Q000737:chemistry; D016207:Cytokines / Q000032:analysis* / Q000097:blood; D005122:Exudates and Transudates / Q000737:chemistry; D005260:Female; D006801:Humans; D007375:Interleukin-1 / Q000097:blood; D015850:Interleukin-6 / Q000097:blood; D016471:Ovarian Hyperstimulation Syndrome / Q000150:complications*; D010996:Pleural Effusion / Q000737:chemistry* / Q000000981:diagnostic imaging / Q000209:etiology / Q000628:therapy; D012016:Reference Values; D014409:Tumor Necrosis Factor-alpha / Q000032:analysis; D014463:Ultrasonography
D016207:Cytokines; D007375:Interleukin-1; D015850:Interleukin-6; D014409:Tumor Necrosis Factor-alpha