title: Mixed Connective Tissue Disorder Complicated by Polymyositis, Sjogren's Syndrome, Pleural Effusion and Pericarditis.
abstract: We report a case of a 24-year-old female with a history of asthma and gastroesophageal reflux disease (GERD). She presented to the emergency room with severe chest pain, chest tightness, and shortness of breath following an upper respiratory tract infection. The patient reported that she had a cough and runny nose one week prior to this presentation, followed by a sudden sharp pain in the center of the chest 8/10 in intensity on the visual analog scale and pleuritic in nature, which aggravated by deep breathing and lying down flat. It was relieved by sitting up straight and did not radiate to her left arm or jaw. Computed tomography (CT) scan of the chest, posteroanterior and lateral views, showed a mild left pleural effusion with adjacent left basilar atelectasis/infiltrate. CT angiography of the chest with axial contrast showed mild left pleural effusion as well as a small pericardial effusion with bilateral lower lobe interstitial infiltrates. There was no evidence of pulmonary embolism. Electrocardiogram (EKG) showed no apparent ST segment elevation or depression that would be consistent with pericarditis, or acute ischemia or infarct. There was non-specific T wave abnormality. The patient was prescribed prednisone on a tapering dose. On follow-up visit, her condition significantly improved.
authors.affiliation: Department of Internal Medicine, Carthage Area Hospital, New York, USA.
authors.forename: Maryam
authors.initials: M
authors.lastname: Kundi
authors.affiliation: Department of Medicine, Shifa Tameer-e-Millat University, Islamabad, Pakistan.
authors.forename: Salman
authors.initials: S
authors.lastname: Assad
authors.affiliation: Khyber Medical University.
authors.forename: Sumbal
authors.initials: S
authors.lastname: Babar
authors.affiliation: Department of Medicine, Shifa International Hospital, Islamabad, Pakistan.
authors.forename: Usman
authors.initials: U
authors.lastname: Ghani
authors.affiliation: Department of Internal Medicine, Shifa International Hospital, Islamabad, Pakistan.
authors.forename: Sahla
authors.initials: S
authors.lastname: Hammad
authors.affiliation: Family Medicine Residency, UHS Wilson Medical Center Johnson City, NY.
authors.forename: Ahmed G
authors.initials: AG
authors.lastname: Sheikh
authors.affiliation: Department of Internal Medicine, Carthage Area Hospital, New York, USA.
authors.forename: Asif K
authors.initials: AK
authors.lastname: Kundi
authors.affiliation: Department of Internal Medicine, Carthage Area Hospital, New York, USA.
authors.forename: Amjad
authors.initials: A
authors.lastname: Sheikh
keywords: connective tissue disease; pleural efffusion; steroids