Ans : systemic lupus erythematosus with pleural and pericardial involvement. CT scan shows pleural effusion of the left lung, as well as pericardial effusion. Related Self Assessment Question Question 1 of 3 A 36-year-old White female comes to your office complaining of an unintentional 15-lb weight loss in the last 3 months. Her review of systems is notable for fatigue, a skin rash over her face and upper chest, hair loss, mild bilateral knee swelling, and shortness of breath with exertion. On physical examination, there is an erythematosus macular rash on her face and upper chest. She has a pericardial friction rub and a normal pulmonary examination. She has mild bilateral knee swelling and tenderness. Which of the following laboratory tests would be most likely to help in diagnosing this patient's condition? A. complete blood count B. comprehensive metabolic panel C. CRP D. antinuclear antibody E. RF The answer is D. Question 2 of 3 A 36-year-old White female comes to your office complaining of an unintentional 15-lb weight loss in the last 3 months. Her review of systems is notable for fatigue, a skin rash over her face and upper chest, hair loss, mild bilateral knee swelling, and shortness of breath with exertion. On physical examination, there is an erythematosus macular rash on her face and upper chest. She has a pericardial friction rub and a normal pulmonary examination. She has mild bilateral knee swelling and tenderness. A CXR would be most likely to show which of the following? A. cardiomegaly B. bilateral pulmonary congestion C. bilateral pleural effusion D. pulmonary fibrosis E. diffuse bilateral infiltrates The answer is A. Question 3 of 3 A 36-year-old White female comes to your office complaining of an unintentional 15-lb weight loss in the last 3 months. Her review of systems is notable for fatigue, a skin rash over her face and upper chest, hair loss, mild bilateral knee swelling, and shortness of breath with exertion. On physical examination, there is an erythematosus macular rash on her face and upper chest. She has a pericardial friction rub and a normal pulmonary examination. She has mild bilateral knee swelling and tenderness. You institute appropriate therapy and 2 months later the patient returns for follow-up. She is feeling much better, has regained some of her weight, her skin rash has resolved, and her knee pain has improved. She would like to get pregnant in the next few months. Regarding pregnancy, you advise her of which of the following? A. She can get pregnant at any time as she is much better now. B. She should wait until her symptoms resolve completely and she regains her initial weight. C. She can get pregnant, but she needs to stop her medications now. D. She should wait until the disease has been quiescent for at least 6 months. E. This is a life-long disease that needs chronic treatment; therefore, she should not attempt to become pregnant. The answer is D. EXPLANATION: systemic lupus erythematosus (SLE) is diagnosed by the presence of 4 of the following 11 signs or symptoms: malar rash; discoid rash; photosensitivity; oral ulcers; arthritis; serositis; renal disorder; neurologic disorder; hematologic disorder; immunologic disorder; ANA. In this case, the patient has the presence of a characteristic rash, arthritis, and serositis (pericardial friction rub suggestive of a pericardial effusion). The presence of ANA on blood testing would, therefore, be diagnostic for SLE. The other tests listed may be helpful but are nonspecific. All of the CXR findings listed can occur in the presence of SLE. Pericarditis is the most common manifestation of cardiac lupus and effusions can occur. Pleurisy and pleural effusions are also common. lupus pneumonitis can cause fleeting infiltrates on x-ray, but the most common cause of pulmonary infiltrates in patients with SLE is infection. SLE can lead to recurrent pregnancy loss. Reports have indicated that during pregnancy, approximately one-third of women reported that their lupus improved, one-third stayed the same, and one-third worsened. In general, pregnancy outcomes are better if the disease has been quiescent for at least 6 months, there is no active renal involvement, superimposed preeclampsia does not develop, and there is no evidence of antiphospholipid antibody. (Y)
pericardial effusion+left pleural effusion findinges are consistent with Pericarditis and Pleurisy due to SLE
