Mixed Connective Tissue Disorder Complicated by Polymyositis, Sjogren’s Syndrome, Pleural Effusion and Pericarditis

Abstract

We report a case of a 24-year-old female with a history of asthma and gastroesophageal reflux disease (GERD). She presented to the emergency room with severe chest pain, chest tightness, and shortness of breath following an upper respiratory tract infection. The patient reported that she had a cough and runny nose one week prior to this presentation, followed by a sudden sharp pain in the center of the chest 8/10 in intensity on the visual analog scale and pleuritic in nature, which aggravated by deep breathing and lying down flat. It was relieved by sitting up straight and did not radiate to her left arm or jaw. Computed tomography (CT) scan of the chest, posteroanterior and lateral views, showed a mild left pleural effusion with adjacent left basilar atelectasis/infiltrate. CT angiography of the chest with axial contrast showed mild left pleural effusion as well as a small pericardial effusion with bilateral lower lobe interstitial infiltrates. There was no evidence of pulmonary embolism. Electrocardiogram (EKG) showed no apparent ST segment elevation or depression that would be consistent with pericarditis, or acute ischemia or infarct. There was non-specific T wave abnormality. The patient was prescribed prednisone on a tapering dose. On follow-up visit, her condition significantly improved.

Incidence and Clinical Pattern of Mixed Connective Tissue Disease in Sudanese Patients at Omdurman Military Hospital: Hospital-Based Study

“…The first diagnosis in 10% had a full blown picture of MCTD (SLE, SS, DM), is similar to a study in Minnesota, USA which reported that the annual incidence of MCTD was 1.9 per 100,000 population. 20 Our study showed that 40% evolved from SLE, 26.7% evolved from RA, 6.7% from SS, and 3.3% evolved from PM to MCTD, similar to a study in Pakistan which found that, over the disease course of 6 years, 10% of patients evolved into SLE. Also this is comparable to the Minnesota study, in which evolution from other connective tissue diseases occurred at 8.5% and 6.3% for SLE and SS, respectively.…”

Pleural Diseases in Connective Tissue Diseases

“…78,113,114 As effusions tend to be small in MCTD, they do not require symptomatic drainage and can resolve with the treatment of underlying disease. 115 MCTD patients are treated with medications controlling specific symptoms, i.e., nonsteroidal anti-inflammatory drugs and antimalarials for arthralgias and myalgias, calcium channel blockers for Raynaud's phenomenon. Short courses of corticosteroids are commonly used and pleural disease is particularly responsive to this treatment.…”