Abstract
BackgroundPleural effusion in systemic lupus erythematous (SLE) is a common symptom, and recent studies demonstrated that IL-6 has a pivotal role in its pathogenesis.Case presentationWe report a case of a 15 years old Caucasian boy with a history of persistent pleural effusion without lung involvement or fever. Microbiological and neoplastic aetiologies were previously excluded. Based on the presence of pleuritis, malar rash, reduction of C3 and C4 levels and positivity of antinuclear antibody (ANA) and anti-double stranded DNA (dsDNA), the diagnosis of juvenile SLE (JSLE) was performed. Treatment with high dose of intravenous glucocorticoids and mycophenolate mofetil was started with partial improvement of pleural effusion. Based on this and on adults SLE cases with serositis previously reported, therapy with intravenous tocilizumab (800 mg every two weeks) was started with prompt recovery of pleural effusion.ConclusionTo the best of our knowledge, this is the first case of JSLE pleuritis successfully treated with tocilizumab.
Highlights
Pleural effusion in systemic lupus erythematosus (SLE) occurs in 50 % of the patients
To the best of our knowledge, this is the first case of juvenile systemic lupus erythematous (SLE) (JSLE) pleuritis successfully treated with tocilizumab
We describe a patient with juvenile onset-SLE (JSLE) and massive refractory pleural effusion treated with tocilizumab (TCZ)
Summary
Introduction Pleural effusion in systemic lupus erythematosus (SLE) occurs in 50 % of the patients. We describe a patient with juvenile onset-SLE (JSLE) and massive refractory pleural effusion treated with tocilizumab (TCZ). Two cases of adult SLE patients with pleuritis successfully treated with TCZ have been reported [2, 3]. Laboratory features showed leukopenia (2.38 × 103/uL), lymphopenia (0.89 × 103/uL), hypergammaglobulinemia (22.31 g/l) and normal C-reactive protein (CRP) (< 0.5 mg/dl); antinuclear antibody (ANA) and anti-dsDNA were negative.
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