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Chyliform effusion without pleural thickening in a patient with rheumatoid arthritis: A case report.

Muresan C, Muresan L, Grigorescu I, Dumitrascu DL - Lung India (2015 Nov-Dec)

Bottom Line: Pseudochylothorax, also known as chyliform effusion rich in cholesterol crystals, is a rare entity that sometimes occurs in long-standing rheumatoid arthritis (RA) and is usually associated with thickened pleura.We report the case of a 70-year-old male patient with a history of RA and heart failure due to severe aortic stenosis, who presented with signs and symptoms of decompensated heart failure due to a moderate right-sided pleural effusion that was consequently proved to be pseudochylothorax unassociated with pleural thickening on chest computed tomography (CT) scan.The patient's outcome was favorable after thoracocentesis was carried out and leflunomide was added to the standard heart failure treatment.

View Article: PubMed Central - PubMed

Affiliation: Department of 2nd Medical Clinic, Division of Internal Medicine, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania.

ABSTRACT
Pseudochylothorax, also known as chyliform effusion rich in cholesterol crystals, is a rare entity that sometimes occurs in long-standing rheumatoid arthritis (RA) and is usually associated with thickened pleura. There have only been a few case reports in the literature on pseudochylothorax unassociated with pleural thickening and with a short duration of articular symptoms in patients with RA. We report the case of a 70-year-old male patient with a history of RA and heart failure due to severe aortic stenosis, who presented with signs and symptoms of decompensated heart failure due to a moderate right-sided pleural effusion that was consequently proved to be pseudochylothorax unassociated with pleural thickening on chest computed tomography (CT) scan. The patient's outcome was favorable after thoracocentesis was carried out and leflunomide was added to the standard heart failure treatment.

No MeSH data available.


Related in: MedlinePlus

Optical microscopy showing cholesterol crystals (40X magnification)
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Figure 3: Optical microscopy showing cholesterol crystals (40X magnification)

Mentions: Treatment with loop diuretics, oxygen, and bronchodilators was initiated. Thoracocentesis was carried out and 900 ml of turbid, yellow fluid was evacuated [Figure 2]. Biochemical analysis of the fluid demonstrated an exudative nature: Total proteins 7.87 mg/dL, lactate dehydrogenase (LDH) 1122 U/L, pleural LDH/serum LDH ratio of 3.25, cholesterol 148 mg/dL, triglycerides 41 mg/dL, and glucose 59 mg/dL (NV: 70-110 mg/dL). A low level of complement C3 and C4 at 0.04 g/L and 0 g/L, respectively, was also noted. On microscopic examination, cholesterol crystals were observed [Figure 3]. Microbiological smears and cultures were negative, including for Mycobacterium tuberculosis.


Chyliform effusion without pleural thickening in a patient with rheumatoid arthritis: A case report.

Muresan C, Muresan L, Grigorescu I, Dumitrascu DL - Lung India (2015 Nov-Dec)

Optical microscopy showing cholesterol crystals (40X magnification)
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4663869&req=5

Figure 3: Optical microscopy showing cholesterol crystals (40X magnification)
Mentions: Treatment with loop diuretics, oxygen, and bronchodilators was initiated. Thoracocentesis was carried out and 900 ml of turbid, yellow fluid was evacuated [Figure 2]. Biochemical analysis of the fluid demonstrated an exudative nature: Total proteins 7.87 mg/dL, lactate dehydrogenase (LDH) 1122 U/L, pleural LDH/serum LDH ratio of 3.25, cholesterol 148 mg/dL, triglycerides 41 mg/dL, and glucose 59 mg/dL (NV: 70-110 mg/dL). A low level of complement C3 and C4 at 0.04 g/L and 0 g/L, respectively, was also noted. On microscopic examination, cholesterol crystals were observed [Figure 3]. Microbiological smears and cultures were negative, including for Mycobacterium tuberculosis.

Bottom Line: Pseudochylothorax, also known as chyliform effusion rich in cholesterol crystals, is a rare entity that sometimes occurs in long-standing rheumatoid arthritis (RA) and is usually associated with thickened pleura.We report the case of a 70-year-old male patient with a history of RA and heart failure due to severe aortic stenosis, who presented with signs and symptoms of decompensated heart failure due to a moderate right-sided pleural effusion that was consequently proved to be pseudochylothorax unassociated with pleural thickening on chest computed tomography (CT) scan.The patient's outcome was favorable after thoracocentesis was carried out and leflunomide was added to the standard heart failure treatment.

View Article: PubMed Central - PubMed

Affiliation: Department of 2nd Medical Clinic, Division of Internal Medicine, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania.

ABSTRACT
Pseudochylothorax, also known as chyliform effusion rich in cholesterol crystals, is a rare entity that sometimes occurs in long-standing rheumatoid arthritis (RA) and is usually associated with thickened pleura. There have only been a few case reports in the literature on pseudochylothorax unassociated with pleural thickening and with a short duration of articular symptoms in patients with RA. We report the case of a 70-year-old male patient with a history of RA and heart failure due to severe aortic stenosis, who presented with signs and symptoms of decompensated heart failure due to a moderate right-sided pleural effusion that was consequently proved to be pseudochylothorax unassociated with pleural thickening on chest computed tomography (CT) scan. The patient's outcome was favorable after thoracocentesis was carried out and leflunomide was added to the standard heart failure treatment.

No MeSH data available.


Related in: MedlinePlus