Treatment of chronic bilateral pleural effusions with intravenous immunoglobulin and cyclosporin.
A 48 y old woman with unremarkable medical history was admitted with bilateral pleural effusions; even though the fluid was drained, it re-accumulated and necessitated many repeated drainages in the following 2.5 y (56 hospitalisations). The patient underwent an extensive diagnostic work-up that disclosed elevated serum antinuclear antibodies, serum anti-dsDNA antibodies, pleural fluid anti-dsDNA and decreased pleural fluid C3 and C4. During that period she has been treated with a variety of immunomodulating agents, several pleural talcage and pleurectomy, without any apparent response. Thereafter, she received six courses of IVIg (2 g/kg body weight) in monthly intervals, followed by four months treatment with cyclosporin. This treatment resulted in gradual and eventually complete disappearance of the pleural effusion, and now after more than 2 y the patient is free of symptoms and receives no further medications.
Department of Medicine B, Sheba Medical Center, Tel-Hashomer, Israel.
Y
Y
Sherer
P
P
Langevitz
Y
Y
Levy
F
F
Fabrizzi
Y
Y
Shoenfeld
D000974:Antibodies, Antinuclear / Q000097:blood; D001201:Ascites / Q000188:drug therapy / Q000209:etiology / Q000276:immunology; D003176:Complement C3 / Q000032:analysis; D003181:Complement C4 / Q000032:analysis; D016572:Cyclosporine / Q000008:administration & dosage*; D004247:DNA / Q000276:immunology; D005260:Female; D006801:Humans; D016756:Immunoglobulins, Intravenous; D007166:Immunosuppressive Agents / Q000008:administration & dosage*; D008180:Lupus Erythematosus, Systemic / Q000150:complications*; D008875:Middle Aged; D010994:Pleura / Q000737:chemistry; D010996:Pleural Effusion / Q000188:drug therapy* / Q000209:etiology* / Q000276:immunology
D000974:Antibodies, Antinuclear; D003176:Complement C3; D003181:Complement C4; D016756:Immunoglobulins, Intravenous; D007166:Immunosuppressive Agents; D016572:Cyclosporine; D004247:DNA