Markedly elevated cytokines in pleural effusion during the ovarian hyperstimulation syndrome: transudate or ascites?

Abstract

Objective: To study levels of proinflammatory cytokines in pleural fluid during the severe ovarian hyperstimulation syndrome (OHSS). Design: Case report. Setting: Tertiary academic medical center. Patient(s): A 35-year-old female with a 6-year history of unexplained infertility on menotropin therapy and 28 healthy normal controls. Intervention(s): Thoracentesis for severe pleural effusion and venipunctures. Main Outcome Measure(s): Interleukin-1β (IL-β), interleukin-6 (IL-6), and tumor necrosis factor-α (TNF-α) levels were measured by ELISA and compared between pleural effusion and serum from normal controls. Result(s): Pleural effusion IL-1β and IL-6 levels were higher than serum. Interleukin-6 levels were elevated particularly in pleural effusion (1,961.89 pg/mL) compared with serum (3.9 ± 0.41 pg/mL). Conclusion(s): Our results confirm the high cytokine levels observed in OHSS. Cytokines have been implicated in capillary permeability, extravasation of fluid, oliguria, and shock. We have postulated that these mediators are released from the corpora lutea into the peritoneum and systemic circulation. Alternatively, the presence of high cytokine levels in pleural fluid maybe the result of diaphragmatic defects, which allow for the migration of ascites into the pleural space.