Disorders of the Pleura |

An 80-Year-Old Man With Fever, Dyspnea, Pleuritic Chest Pain, and Joint Pains FREE TO VIEW

Taha Bekci, MD; Mustafa Calik, MD; Hilal Kocabas, MD; Saniye Calik, MD; Ozgur Acal, MD; Ercan Kurtipek, MD
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Department of Pulmonary Medicine, Konya Education and Research Hospital, Konya, Turkey

Chest. 2014;146(4_MeetingAbstracts):472A. doi:10.1378/chest.1994177
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SESSION TITLE: Pleural Disease Global Case Reports

SESSION TYPE: Global Case Report

PRESENTED ON: Tuesday, October 28, 2014 at 01:30 PM - 02:30 PM

INTRODUCTION: 80-year-old man was admitted to our Emergency Department with complaint of fever, chill, pleuritic chest pain, dyspnea, cough, fatigue, and migratory joint pain.

CASE PRESENTATION: He had joint pain especially in metacarpophalangeal and proximal interphalangeal joints in past 6 weeks. The chest x-ray and CT showed bilateral pleural effusion image dominantly in left hemithorax, and minimal parencymal infiltration. Blood analysis showed leucocytosis 17.000 K/uL, hgb: 13,1 gr/dl, CRP:150 mg/l, Sedim: 70 mm/h, ANA was borderline, anti-ds DNA was (-), Anti CCP was (-) and RF 403 iU/ml elevated. Thoracentesis was performed, and analysis revealed the following: Gluc 46 mg/dl, alb 2,3 g/dl, protein 4,3 g/dl, LDH 1015 U/L; gram stain showed 5-6 leucocyte in every region and no microorganism. Despite to the high LDH level in, fluid appaerance was not concordant with empyema. Culture, AFP and Mycobacteria culture was negative in fluid. Broadspectrum antimicrobial therapy and 0.5 mg/kg Methyl Prednisolon was initiated. Patient’s symptoms and laboratory findings were completely improved in two weeks. However, the patient come back to our department with same symptoms 3 weeks later. PET CT was performed to exclude malign disorder, there was no malignity suspecious lesion in PET CT. We consultated patient with Rheumatology Clinic. Bilateraly AP hand graphy showed erosions and sclerosis metacarpophalangeal and proximal interphalangeal joints.

DISCUSSION: The American College of Rheumatology (ACR) classification criteria for RA include the following: morning joint stiffness persisting at least 1 hour; arthritis of 3 or more joint areas; arthritis of the proximal interphalangeal, metacarpophalangeal, and wrist joints; symmetric arthritis; rheumatoid nodules; positive RF; and erosions or periarticular osteopenia in hand/wrist joints. The first 4 criteria must be present for at least 6 weeks. Four of 7 criteria are required for classification as RA. Retrospectively, our patient fulfilled only 3 of these criteria (1). Rheumatology Clinic iniated RA treatment according to the American College of Rheumatology classification criterias. After two months of treatment with methotrexate the patient continious to do well.

CONCLUSIONS: RA with may be occured in late decade, and present with pulmonary involvement symptomes.

Reference #1: 1-Arnett FC, Edworthy SM, Bloch DA. The American Rheumatism Association 1987 revised criteria for the classification of rheumatoid arthritis. Arthritis Rheum. 1988;31(3):315-324.

DISCLOSURE: The following authors have nothing to disclose: Taha Bekci, Mustafa Calik, Hilal Kocabas, Saniye Calik, Ozgur Acal, Ercan Kurtipek

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