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Treatment of chronic bilateral pleural effusions with intravenous immunoglobulin and cyclosporin

Department of Medicine B and Research Unit of Autoimmune Diseases, Sheba Medical Center, Tel-Hashomer, and Sackler Faculty of Medicine, Tel-Aviv University, Israel

P Langevitz

Rheumatology Unit, Sheba Medical Center, Tel-Hashomer, and Sackler Faculty of Medicine, Tel-Aviv University, Israel

Y Levy

Department of Medicine B and Research Unit of Autoimmune Diseases, Sheba Medical Center, Tel-Hashomer, and Sackler Faculty of Medicine, Tel-Aviv University, Israel

F Fabrizzi

Clinical trial consultant, Lucca, Italy

Y Shoenfeld

Department of Medicine B and Research Unit of Autoimmune Diseases, Sheba Medical Center, Tel-Hashomer, and Sackler Faculty of Medicine, Tel-Aviv University, Israel

A 48 y old woman with unremarkable medical history was admitted with bilateral pleural effusions; even though the fluid was drained, it re-accumulated and necessitated many repeated drainages in the following 2.5 y (56 hospitalisations). The patient underwent an extensive diagnostic work-up that disclosed elevated serum antinuclear antibodies, serum anti-dsDNA antibodies, pleural fluid anti-dsDNA and decreased pleural fluid C3 and C4. During that period she has been treated with a variety of immunomodulating agents, several pleural talcage and pleurectomy, without any apparent response. Thereafter, she received six courses of IVIg (2 g/kg body weight) in monthly intervals, followed by four months treatment with cyclosporin. This treatment resulted in gradual and eventually complete disappearance of the pleural effusion, and now after more than 2 y the patient is free of symptoms and receives no further medications.

Key Words: autoimmunity • cyclosporin • intravenous immunoglobulin • pleural effusion • systemic lupus erythematosus

Lupus, Vol. 8, No. 4, 324-327 (1999)
DOI: 10.1191/096120399678847759


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