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Pulmonary, Critical Care, and Sleep Pearls |

A 26-Year-Old Woman With Systemic Lupus Erythematosus Presenting With Orthopnea and Restrictive Lung Impairment

Tanmay S. Panchabhai, MD, FCCP; Debabrata Bandyopadhyay, MD; Kristin B. Highland, MD, FCCP; Neal F. Chaisson, MD; Loutfi S. Aboussouan, MD, FCCP
Author and Funding Information

CORRESPONDENCE TO: Loutfi S. Aboussouan, MD, FCCP, Cleveland Clinic, Department of Pulmonary Medicine, Respiratory Institute, 9500 Euclid Avenue /A90, Cleveland, OH, 44195


Copyright 2016, American College of Chest Physicians. All Rights Reserved.


Chest. 2016;149(1):e29-e33. doi:10.1016/j.chest.2015.10.053
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A 26-year-old white woman diagnosed with systemic lupus erythematosus (SLE) presented with left shoulder pain and a three-pillow orthopnea. Lupus was diagnosed at age 21 years when she developed arthritis, and she has been maintained on prednisone (2.5 mg) and mycophenolate (500 mg bid). In the course of evaluating her new symptoms, imaging revealed a small left pleural effusion with exudative characteristics on a diagnostic thoracentesis, but there was no evidence of infection. Her immunosuppression treatment was increased to 1,000 mg bid of mycophenolate and 20 mg of prednisone. Three months later, she presented to our clinic with worsening six-pillow orthopnea, such that she usually slept with 45° truncal elevation on a recliner at night. She was unable to lie flat. Her dyspnea was worse in the mornings, and she described having to “gasp” for air.

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