Fernández-Muixí J, Vidal F, Razquín S, Torre L, Richart C
Servicio de Medicina Interna, Hospital de Tarragona Joan XXIII.
Arch Bronconeumol. 1996 Oct;32(8):427-9. doi: 10.1016/s0300-2896(15)30729-8.
A 24-year-old woman with an unremarkable history presented with a large right-sided pleural effusion. Analysis of the pleural fluid showed a sterile exudate with a low sugar level. Complementary analyses were unable to pinpoint the etiology. The effusion was drained and the patient was released with no specific diagnosis. Nine months later the effusion recurred and the initial laboratory analyses were the same. Pleural fluid cytology revealed the presence of an amorphous necrotic background and non-small cells with multiple nuclei, two signs that constitute part of the pathognomonic triad of rheumatoid pleural effusions, the third characteristic benign fusiform histocytes. The biochemical characteristics of the pleural fluid thus suggested rheumatoid pleural effusion, and cytology confirmed the diagnosis. Corticoid therapy effected spectacular recovery, but when the dose was reduced, rheumatoid symptoms presented in the joints. Rheumatoid arthritis should be considered as a possible explanation for unexplained pleural effusion. Cytology must be used for diagnosis.
一名既往史无特殊的24岁女性出现右侧大量胸腔积液。胸腔积液分析显示为无菌性渗出液，糖含量低。补充检查未能明确病因。胸腔积液被引流，患者出院时未明确诊断。9个月后胸腔积液复发，初始实验室检查结果相同。胸腔积液细胞学检查发现有无定形坏死背景和多核非小细胞，这两个征象是类风湿性胸腔积液特征性三联征的一部分，第三个特征是良性梭形组织细胞。胸腔积液的生化特征提示为类风湿性胸腔积液，细胞学检查确诊。皮质类固醇治疗使病情显著好转，但当剂量减小时，关节出现类风湿症状。类风湿性关节炎应被视为不明原因胸腔积液的一种可能解释。必须通过细胞学检查进行诊断。
