Pseudochylothorax Secondary to Rheumatoid Arthritis: Case Report

Abstract

1274 seudochylothorax, which is also termed as chyliform pleural effusion or cholesterol pleural effusion is an entity that develops as a result of increase in the amount of cholesterol in fluids with long-standing exudative characteristics and resembles to chylothorax.1 It is generally observed in pleural effusions lasting more than five years.2 Up to 1999, a total of 29 publications and 172 case reports regarding pseudochylothorax which is a rare form of pleural effusions have been cited in the literature. 3 The most common causes of pseudochylothorax are tuberculous pleurisy, chroPseudochylothorax Secondary to Rheumatoid Arthritis: Case Report A AB BS S T TR RA AC CT T A 61-year-old women was referred to our clinic because of bilateral pleural fluid in her chest X-ray. Her history revealed that swelling and stiffness in her joints was diagnosed as rheumatoid arthritis five years ago. On admission, the patient had no complaints, appeared well, and her vital signs were normal. Lung examination revealed that breath sounds were diminished in both lung bases. We did thoracentesis which yielded a milky-odorless fluid. Biochemical characteristics of the fluid was consistent with exuda; trigliseride: 20 mg/dl, cholesterol: 286 mg/dl. Direct smear and culture for acid fast bacilli were negative. Thoracic computerized tomography scans revealed bilateral pleural fluid, volume loss of the left lung with ipsilateral shifting of mediastinum. According to clinicoradiological and laboratory findings, we concluded that pseudochylothorax was the result of chronic rheumatoid pleurisy. Since pseudochylothorax is an uncommon entity detected during the analyses of pleural fluids, we intended to present our rarely seen case with pseudochylothorax.K Ke ey y W Wo or rd ds s: : Arthritis, rheumatoid; pleurisy; chylothorax; cholesterol; triglycerides Ö ÖZ ZE ET T Altmış bir yaşında bayan hasta, akciğer grafisinde bilateral plevral efüzyon nedeniyle kliniğimize yönlendirilmiş. Özgeçmişinde; beş yıl önce eklemlerinde şişlik-tutukluk şikayeti olmuş, romatoid artrit tanısı konulmuş. Kliniğimize başvurusunda yakınması yoktu, fizik muayenesinde genel durumu iyi, vital bulguları stabildi. Bilateral akciğer bazallerinde solunum sesleri hafif azalmıştı. Torasentezle alınan mayi sütsü görünümde, kokusuz, biyokimyasal incelemesi eksüda karakterinde, trigliserid: 20 mg/dl, kolesterol: 286 mg/dl idi. Sıvının asit rezistan bakteri teksif ve kültür incelemesi negatifti. Bilgisayarlı toraks tomografisinde bilateral plevral efüzyon, sol akciğerde volüm kaybı, kalp ve mediastende sola deviasyon tespit edildi. Mevcut klinik-laboratuvar ve radyolojik bulgularla kronik romatoid plöreziye bağlı psödoşilotoraks kabul edildi. Psödoşilotoraks plevra sıvıları içinde nadir görüldüğünden olgu sunulmuştur. Handan İNÖNÜ, MD,