A Rare Cause of Pleural Effusion: Ankylosing Spondylitis

Ankylosing spondylitis (AS) is a seronegative spondyloarthropathy involving the axial skeleton and major joints. Pleuropulmonary involvement is rare manifestation of AS mostly presented as apical fibrobullous disease and pleural thickening. Herein, we re- port a rare case with right sided pleural effusion in a male patient that was determined on a chest x-ray performed routinely before initiation of anti-TNF therapy. Pleural effusion was a lymphocytic exudate with a normal glucose level. The histopathologi- cal examination of closed pleural biopsy revealed nonspecific chronic inflammato- ry cell infiltration. The patient was followed up with etanercept treatment. One year after the initiation of therapy, due to persistent pleural effusion, video assisted thoracoscopic surgery was performed. Pleural biopsies were also consistent with chronic inflammation.

___

Kanathur N, Lee-Chiong T. Pulmonary manifestations of ankylosing spondylitis. Clin Chest Med 2010; 31: 547–54.

Rosenow EC, Strimlan CV, Muhm JR, et al. Pleuropulmonary manifestations of ankylosing spondylitis. Mayo Clin Proc 1977; 52: 641-9.

Tanoue LT. Pulmonary involvement in collagen vascular disease: a review of the pulmonary manifestations of the Marfan syndrome, ankylosing spondylitis, Sjögren’s syn- drome, and relapsing polychondritis. J Thorac Imaging 1992; 7: 62–77.

Nagyhegyi G, Nadas I, Banyai F, et al. Cardiac and cardio- pulmonary disorders in patients with ankylosing spondy- litis and rheumatoid arthritis. Clin Exp Rheumatol 1988; 6: 17–26.

Parry SD, Barbatzas C, Peel ET, Barton JR. Sulphasalazine and lung toxicity. Eur Respir J 2002; 19: 756-64.

Sahn SA. Pathogenesis of pleural effusions and pleural lesions. In: Cannon GW, Zimmermann GA, editors. The lung in rheumatic disease. New York: Marcel Dekker; 1990. 27–45.

Braun Jv, Van Den Berg R, et al. 2010 update of the ASAS/ EULAR recommendations for the management of anky- losing spondylitis. Ann Rheum Dis 2011; 70: 896-904.

Kinnear WMJ, Shneerson JM. Acute pleural effusion in inactive ankylosing spondylitis. Thorax 1985; 40: 150-1.

Tanaka H, Itoh E, Shibusa T, et al. Pleural effusion in ankylosing spondylitis: successful treatment with intra-pleural steroid administration. Respir Med 1995; 89: 509-11.

Erkan L, Uzun O, Findik S, et al. Isolated pleural and pericardial effusion in a patient with ankylosing spondylitis. Respir Med 2007; 101: 356-8.

Maxwell LJ, Zochling J, Boonen A, et. al. TNF-alpha inhibitors for ankylosing spondylitis. Cochrane Database of Systematic Reviews, 2015.