Massive pleural effusion in systemic lupus erythematosus

A 27-year-old woman, with a 2 month diagnosis of systemic lupus erythematosus (SLE) characterized by hematologic abnormalities (lymphopenia and low platelets), as well as mucocutaneous lesions (hair loss and malar erythema), arthritis, and serositis (pleural and pericardial effusion), with positive antinuclear antibodies (ANA) 1:1.280 with a speckled pattern and positive native anti-DNA >250 U/mL, as well as positive anti-Ro and anti-Sm antibodies, had been receiving treatment with prednisone, 40 mg a day, and azathioprine, 100 mg a day since a month earlier. She came into the clinic due to facial and bilateral maleoli edema, without dyspnea. A massive right pleural effusion was documented (Figures 1-3), and a diagnostic-therapeutic thoracocenthesis was performed. A fluid characterized as an exudate was obtained, with positive Figure 1. Posteroanterior chest x-ray showing a right pleural effusion.