title: Successful treatment of recurrent pleural and pericardial effusions with tocilizumab in a patient with systemic lupus erythematous.
abstract: A 22-year-old Caucasian man presented to hospital with pleuritic chest pain. He had had a history of a sun-sensitive rash a year prior. Workup revealed normal cardiac enzymes and chest X-ray. However, electrocardiogram revealed ST elevation and PR depression, and echocardiogram revealed a slight pericardial effusion without other findings. A diagnosis of pericarditis was made. Subsequently, he was found to be positive for antinuclear antibodies (ANAs), as well as antibodies to SSA, SSB and double-stranded DNA; C3 was low, and C4 was undetectable. A diagnosis of systemic lupus erythematosus was made. The patient initially responded to high-dose ibuprofen. One month later, he developed a new pericardial effusion, this time with concomitant massive left-sided pleural effusion, requiring three separate thoracenteses draining a total of 6 L of pleural fluid. The recurrent effusion failed to respond to high-dose corticosteroid treatment. Owing to the severity and rapidity of the recurrence of pleural and pericardial effusion, intravenous tocilizumab was administered. The patient had excellent clinical and radiographic improvement. This case shows that tocilizumab may have a role in the treatment of intractable pleuropericardial effusion and other forms of lupus-associated serositis.
authors: Internal Medicine Program, McMaster University, Hamilton, Ontario, Canada.
authors: Vanessa
authors: V
authors: Ocampo
authors: Department of Medicine, McMaster University, Hamilton, Ontario, Canada The Waterside Clinic, Barrie, Ontario, Canada.
authors: Derek
authors: D
authors: Haaland
authors: Division of Rheumatology, Department of Medicine, McMaster University, Hamilton, Ontario, Canada.
authors: K
authors: K
authors: Legault
authors: Division of Rheumatology, University of Toronto, Toronto, Ontario, Canada.
authors: Shika
authors: S
authors: Mittoo
authors: The Waterside Clinic, Barrie, Ontario, Canada.
authors: Emily
authors: E
authors: Aitken
mesh_terms: D061067:Antibodies, Monoclonal, Humanized / Q000627:therapeutic use*; D006801:Humans; D008180:Lupus Erythematosus, Systemic / Q000150:complications*; D008297:Male; D010490:Pericardial Effusion / Q000209:etiology / Q000628:therapy*; D010996:Pleural Effusion / Q000209:etiology / Q000628:therapy*; D012008:Recurrence; D000069258:Thoracentesis; D055815:Young Adult
chemical_list: D061067:Antibodies, Monoclonal, Humanized; C502936:tocilizumab