Letter to the Editor
Pleural and Pericardial Effusion in a Patient With Polymyalgia Rheumatica
Derrame pleural y pericárdico en una paciente con polimialgia reumática
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"Leukemic Pleural Effusion: Diagnostic Approach and Controversies in Pleurodesis" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "371" "paginaFinal" => "372" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Derrame pleural leucémico: aproximación diagnóstica y controversias en pleurodesis" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 736 "Ancho" => 983 "Tamanyo" => 177472 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Microscopic examination of pleural fluid, showing cells with lax and immature chromatin, raised nuclear–cytoplasmic 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It is characterized by morning pain and stiffness in the cervical region and in the pectoral and pelvic girdles and may be associated with giant cell arteritis (GCA).<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> Pleural or pericardial effusion is rare in patients with RPM without GCA and is exceptional as a manifestation of disease onset.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">The case of a 76-year-old woman who presented in the emergency room with fever (38<span class="elsevierStyleHsp" style=""></span>°C) is reported. She had had episodes of fever and pain in the pectoral girdle radiating to the cervical region over the previous 2 months. On one occasion, she had received oral corticosteroids in tapering schedule, with improvement. Physical examination revealed a systolic murmur in the aortic region and absent breath sounds in the base of the left lung. Clinical laboratory tests showed C-reactive protein 25.5<span class="elsevierStyleHsp" style=""></span>mg/dl and a small left pleural effusion was observed on the chest X-ray. The initial diagnosis was pneumonia with parapneumonic pleural effusion and the patient was hospitalized with empiric antibiotic therapy. Despite this, her fever persisted and further examinations were performed. The immunological study revealed positive antinuclear antibodies in a speckled pattern. Tumor marker analysis showed elevated CA-125 levels. The chest-abdominal computed tomography showed a small left pleural effusion and minimal pericardial effusion (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). After consultation with the rheumatologist, a diagnosis of RPM with serosal involvement was made and treatment with prednisone (starting dose: 15<span class="elsevierStyleHsp" style=""></span>mg/day) was initiated. Subsequent clinical course was favorable with resolution of fever and pleural effusion. Three months after discharge the patient remained asymptomatic, so the corticosteroid doses were progressively reduced until discontinuation. The patient has since remained asymptomatic, with no new outbreaks of RPM over a 2-year follow-up period.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">Although the elevated CA-125 antigen levels detected in this study may have been caused by other processes, such as Meigs pseudosyndrome secondary to struma ovarii, it was finally interpreted as indicative of serosal involvement. In a review of the literature, only 5 cases of RPM with associated pericardial effusion were identified, of which three also presented pleural effusion. Thoracocentesis was performed in one of these cases. The resulting fluid was borderline transudate/exudate, and cytology was negative for malignancy. In another case, pericardiectomy with pericardial biopsy was performed. Analysis of the pericardial fluid showed proteins 5.2<span class="elsevierStyleHsp" style=""></span>g/dl, lactate dehydrogenase 4562<span class="elsevierStyleHsp" style=""></span>IU/l and glucose 65<span class="elsevierStyleHsp" style=""></span>mg/dl. Histological examination found inflammation with fibrosis and areas of interstitial bleeding with fibrin deposits, and the immunohistochemical analysis revealed lymphocytic infiltrate with predominance of T-cells.<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">In conclusion, RPM should be considered in the differential diagnosis of patients over 50 years of age with pleural and/or pericardial effusion.<a class="elsevierStyleCrossRefs" href="#bib0020"><span class="elsevierStyleSup">4,5</span></a> It is essential to identify the cause of effusion in patients with RPM due to the spectacular response to corticoid treatment.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Jarana Aparicio I, Pedraza Serrano F, de Miguel Díez J. Derrame pleural y pericárdico en una paciente con polimialgia reumática. Arch Bronconeumol. 2014;50:370–371.</p>" ] ] "multimedia" => array:1 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 805 "Ancho" => 1450 "Tamanyo" => 129471 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Chest computed tomography showing small left pleural effusion and minimal pericardial effusion.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:5 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Presentación de un caso de derrame pleurocárdico en un paciente diagnosticado de polimialgia reumática" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "E. 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De Jong" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Am J Med" "fecha" => "2003" "volumen" => "114" "paginaInicial" => "708" "paginaFinal" => "709" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12798467" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/15792129/0000005000000008/v1_201407200014/S1579212914001736/v1_201407200014/en/main.assets" "Apartado" => array:4 [ "identificador" => "14576" "tipo" => "SECCION" "es" => array:2 [ "titulo" => "Letters to the editor" "idiomaDefecto" => true ] "idiomaDefecto" => "es" ] "PDF" => "https://static.elsevier.es/multimedia/15792129/0000005000000008/v1_201407200014/S1579212914001736/v1_201407200014/en/main.pdf?idApp=UINPBA00003Z&text.app=https://archbronconeumol.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1579212914001736?idApp=UINPBA00003Z" ]
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| 2020 October | 40 | 8 | 48 |
| 2020 September | 51 | 16 | 67 |
| 2020 August | 68 | 17 | 85 |
| 2020 July | 58 | 30 | 88 |
| 2020 June | 46 | 5 | 51 |
| 2020 May | 44 | 14 | 58 |
| 2020 April | 35 | 24 | 59 |
| 2020 March | 47 | 16 | 63 |
| 2020 February | 44 | 14 | 58 |
| 2020 January | 57 | 20 | 77 |
| 2019 December | 47 | 17 | 64 |
| 2019 November | 38 | 18 | 56 |
| 2019 October | 39 | 10 | 49 |
| 2019 September | 71 | 12 | 83 |
| 2019 August | 81 | 22 | 103 |
| 2019 July | 60 | 17 | 77 |
| 2019 June | 51 | 19 | 70 |
| 2019 May | 80 | 13 | 93 |
| 2019 April | 88 | 18 | 106 |
| 2019 March | 74 | 23 | 97 |
| 2019 February | 75 | 13 | 88 |
| 2019 January | 62 | 14 | 76 |
| 2018 December | 68 | 16 | 84 |
| 2018 November | 127 | 25 | 152 |
| 2018 October | 160 | 30 | 190 |
| 2018 September | 63 | 15 | 78 |
| 2018 May | 41 | 2 | 43 |
| 2018 April | 62 | 4 | 66 |
| 2018 March | 111 | 4 | 115 |
| 2018 February | 76 | 6 | 82 |
| 2018 January | 176 | 10 | 186 |
| 2017 December | 113 | 9 | 122 |
| 2017 November | 51 | 12 | 63 |
| 2017 October | 54 | 8 | 62 |
| 2017 September | 56 | 7 | 63 |
| 2017 August | 41 | 12 | 53 |
| 2017 July | 31 | 11 | 42 |
| 2017 June | 43 | 20 | 63 |
| 2017 May | 52 | 9 | 61 |
| 2017 April | 38 | 11 | 49 |
| 2017 March | 18 | 5 | 23 |
| 2017 February | 18 | 4 | 22 |
| 2017 January | 22 | 8 | 30 |
| 2016 December | 31 | 6 | 37 |
| 2016 November | 48 | 7 | 55 |
| 2016 October | 48 | 16 | 64 |
| 2016 September | 49 | 12 | 61 |
| 2016 August | 45 | 10 | 55 |
| 2016 July | 38 | 8 | 46 |
| 2016 March | 1 | 0 | 1 |
| 2016 February | 1 | 0 | 1 |
| 2015 December | 3 | 0 | 3 |
| 2015 October | 85 | 4 | 89 |
| 2015 September | 84 | 9 | 93 |
| 2015 August | 77 | 13 | 90 |
| 2015 July | 51 | 10 | 61 |
| 2015 June | 35 | 5 | 40 |
| 2015 May | 42 | 12 | 54 |
| 2015 April | 28 | 7 | 35 |
| 2015 March | 40 | 2 | 42 |
| 2015 February | 27 | 7 | 34 |
| 2015 January | 31 | 5 | 36 |
| 2014 December | 23 | 12 | 35 |
| 2014 November | 20 | 13 | 33 |
| 2014 October | 1 | 0 | 1 |
| 2014 September | 0 | 1 | 1 |
| 2014 July | 1 | 1 | 2 |
Show all
