title: A 26-Year-Old Woman With Systemic Lupus Erythematosus Presenting With Orthopnea and Restrictive Lung Impairment.
abstract: A 26-year-old white woman diagnosed with systemic lupus erythematosus (SLE) presented with left shoulder pain and a three-pillow orthopnea. Lupus was diagnosed at age 21 years when she developed arthritis, and she has been maintained on prednisone (2.5 mg) and mycophenolate (500 mg bid). In the course of evaluating her new symptoms, imaging revealed a small left pleural effusion with exudative characteristics on a diagnostic thoracentesis, but there was no evidence of infection. Her immunosuppression treatment was increased to 1,000 mg bid of mycophenolate and 20 mg of prednisone. Three months later, she presented to our clinic with worsening six-pillow orthopnea, such that she usually slept with 45° truncal elevation on a recliner at night. She was unable to lie flat. Her dyspnea was worse in the mornings, and she described having to "gasp" for air.
authors.affiliation: Norton Thoracic Institute, St Joseph's Hospital and Medical Center, Phoenix, AZ.
authors.forename: Tanmay S
authors.initials: TS
authors.lastname: Panchabhai
authors.affiliation: Department of Pulmonary Medicine, Respiratory Institute, Cleveland Clinic, Cleveland, OH.
authors.forename: Debabrata
authors.initials: D
authors.lastname: Bandyopadhyay
authors.affiliation: Department of Pulmonary Medicine, Respiratory Institute, Cleveland Clinic, Cleveland, OH.
authors.forename: Kristin B
authors.initials: KB
authors.lastname: Highland
authors.affiliation: Department of Pulmonary Medicine, Respiratory Institute, Cleveland Clinic, Cleveland, OH.
authors.forename: Neal F
authors.initials: NF
authors.lastname: Chaisson
authors.affiliation: Department of Pulmonary Medicine, Respiratory Institute, Cleveland Clinic, Cleveland, OH. Electronic address: aboussl@ccf.org.
authors.forename: Loutfi S
authors.initials: LS
authors.lastname: Aboussouan
mesh_terms: D000328:Adult; D004417:Dyspnea / Q000209:etiology*; D005260:Female; D006801:Humans; D008171:Lung Diseases / Q000175:diagnosis* / Q000209:etiology*; D008180:Lupus Erythematosus, Systemic / Q000150:complications*; D010998:Pleurisy / Q000175:diagnosis* / Q000209:etiology*; D013577:Syndrome
keywords: autoimmune lung disease; diaphragmatic dysfunction; pulmonary involvement in SLE; shrinking lung syndrome