DOI: 10.1097/RHU.0b013e3182642527

,  

,  

PMID: 22832304

Issn Print: 1076-1608

Publication Date: 2012/08/01


Print

LE Cells in Pleural Fluid

Gabriel Altit; Pierre Brochu; Sheila V. Jacob; Maria Buithieu

    loading  Checking for direct PDF access through Ovid

Excerpt

An 11-year-old girl with pleuritic chest pain was referred to our center after being diagnosed with a left lower lobe pneumonia and a parapneumonic effusion on a chest radiograph. She had been previously investigated for autoimmune hemolysis and pericarditis, and systemic lupus erythematosus (SLE) was suspected. Later investigations confirmed the presence of anti-DNA antibodies, anti–nuclear antibody, and elevated IgM and IgG anticardiolipins. During the course of her current admission, she developed coca-cola–colored urine, photosensitivity, shoulder and left knee arthralgia without synovitis, and a rash involving the scalp, nasal philtrum, buttocks, and upper legs. Skin biopsy confirmed acute neutrophilic dermatosis (Sweet syndrome). Urine analysis (previously normal) revealed 3 g/L of proteins. Renal biopsy confirmed a class IV SLE nephritis (International Society of Nephrology/Renal Pathology Society).1 Computed tomographic scan of the chest demonstrated a large left pleural effusion.
Histological analysis of the pleural fluid confirmed the presence of numerous neutrophils and macrophages, with some of those cells containing intracytoplasmic basophilic globular bodies positive for anti-IgG on immunohistochemistry and immunofluoresence, suggestive of lupus erythematosus (LE) cells (Figure; macrophage with intracytoplasmic basophilic material). Initially discovered in 1948 by Hargraves et al.2 in the bone marrow and peripheral blood, LE cells have been since described in the pleural, synovial, peritoneal, and pericardial fluid as well as in the skin3 and the CSF.4 These cells are predominantly mononuclear cells or neutrophils that have engulfed the denatured nuclear material of another cell.5 This material appears as a homogenous-looking mass (hematoxylin body) that compresses the nucleus of the phagocyte to the periphery of the cell.6 The occurrence of LE cells in the pleural fluid is considered specific for the diagnosis of SLE.7 Until 1997, the presence of LE cells was part of the diagnostic criteria for SLE as described by the American College of Rheumatology.6 Today, this has been replaced by serology for autoantibodies, now a cornerstone in the diagnosis of SLE.
    loading  Loading Related Articles