title: Systemic lupus erythematosus with initial presentation of empyematous pleural effusion in an elderly male patient: a diagnostic challenge.
abstract: Systemic lupus erythematosus (SLE) poses great difficulty in making an early diagnosis in elderly males, often presenting with atypical manifestations. Acute onset of empyematous pleural effusion has rarely been seen. Herein, we report a 66-year-old man with SLE presenting with rapid progression of bilateral pleural effusion. Diagnostic thoracocentesis disclosed neutrophil-predominant exudates and chest computed tomography revealed multiple loculated pleural effusions. Nevertheless, optimal antibiotic therapy plus surgical decortication of the pleura did not improve his condition. The diagnosis of SLE was readily established after LE cells were accidentally found in the pleural effusion. Large amounts of pleural effusion subsided soon after high dose corticosteroid therapy.
authors.affiliation: Department of Internal Medicine, National Cheng Kung University College of Medicine and Hospital, Tainan City, Taiwan, ROC.
authors.forename: Wei-Ting
authors.initials: WT
authors.lastname: Chang
authors.forename: Tung-Han
authors.initials: TH
authors.lastname: Hsieh
authors.forename: Ming-Fei
authors.initials: MF
authors.lastname: Liu
mesh_terms: D000305:Adrenal Cortex Hormones / Q000008:administration & dosage; D000368:Aged; D000900:Anti-Bacterial Agents / Q000008:administration & dosage; D000893:Anti-Inflammatory Agents / Q000008:administration & dosage; D005122:Exudates and Transudates / Q000166:cytology; D006801:Humans; D008180:Lupus Erythematosus, Systemic / Q000175:diagnosis* / Q000188:drug therapy / Q000473:pathology* / Q000601:surgery; D008297:Male; D010996:Pleural Effusion / Q000175:diagnosis* / Q000209:etiology / Q000473:pathology* / Q000628:therapy; D013902:Radiography, Thoracic; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
chemical_list: D000305:Adrenal Cortex Hormones; D000900:Anti-Bacterial Agents; D000893:Anti-Inflammatory Agents