A Case Report of Pericardial Effusion with False-Positive Mesothelioma and Adenocarcinoma Markers as the Initial Presentation of Systemic Lupus Erythematous

Our plain-English summary of A Case Report of Pericardial Effusion with False-Positive Mesothelioma and Adenocarcinoma Markers as the Initial Presentation of Systemic Lupus Erythematous, by G. Bhattacharya, P.P. Gupta (Case Reports in Rheumatology, 2022).

The study

• Authors: G. Bhattacharya, P.P. Gupta
• Journal: Case Reports in Rheumatology
• Published: 2022;2022:8081055
• Type of article: Case report
• Cited by: 2 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Pericardial effusion or the accumulation of fluid in the pericardial sac, can result from infectious, malignant, or autoimmune processes such as systemic lupus erythematous (SLE). However, pericardial effusion is infrequently the first presentation of SLE. Here, we describe the case of a 54-year-old African American woman who presented with hypertensive emergency and was found to have pericardial effusion on echocardiogram. Her hypertensive symptoms resolved with medical management and a work up were positive for serum markers of SLE and mesothelioma cell markers (calretinin, CK 5/6) and adenocarcinoma marker MOC31 in the pericardial fluid. Her effusion ultimately improved on high-dose steroid therapy and has not recurred in one year. Given normal pleura and pericardium on computed tomography (CT) imaging and long-term clinical improvement in SLE therapy, we hypothesize that she had false-positive mesothelioma markers in the setting of SLE.

Copyright © 2022 Gita Bhattacharya and Pritha P Gupta.

In plain English

This case report described a 54-year-old African American woman with poorly controlled hypertension, a 15 pack-year smoking history and no prior known asbestos exposure. She presented with a hypertensive emergency and was found to have a large fluid collection around the heart (pericardial effusion). Draining it yielded 1160 mL of fluid. Bacterial, viral and fungal studies of the fluid were negative. Immunohistochemistry was positive for calretinin and weakly positive for CK5/6 and MOC31, a pattern suspicious for malignant mesothelioma. Chest CT showed no pericardial or pleural thickening or masses. Based on blood test results together with the pericardial effusion itself, she was classified as having systemic lupus erythematous (SLE), with a score of 15. The effusion shrank on high-dose steroids and was absent at 6 months. At one year she had no symptoms and a normal echocardiogram, though her lupus had progressed. Together with oncology, the care team judged the markers most likely false-positive results, and no further work-up was done. The authors hypothesized that this was a rare instance of false-positive malignancy markers in the setting of lupus.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: case report (one patient)
• Who was studied: One 54-year-old African American woman with poorly controlled hypertension, daily cigarette smoking (15 pack-years) and alpha-thalassemia anemia; treated at UCLA (Los Angeles, USA); followed for one year
• Exposure: No asbestos exposure was studied. The patient had no prior known asbestos exposure. The report concerned mesothelioma and adenocarcinoma markers (calretinin, CK 5/6, MOC31) found in pericardial fluid in a patient with SLE.
• Main results:
  • Drainage of the fluid around the heart (pericardiocentesis) yielded 1160 mL of straw-colored, nonclotting fluid
  • Bacterial, viral and fungal studies of the pericardial fluid were negative
  • Immunohistochemistry of the pericardial fluid was positive for calretinin and weakly positive for CK5/6 and MOC31, which was suspicious for malignant mesothelioma
  • Chest CT showed no pericardial or pleural thickening and no pericardial or pleural masses
  • The patient was classified as having SLE under the 2019 ACR/EULAR criteria, with a score of 15 (greater than 10 is considered diagnostic)
  • The SLE score was based on positive ANA, low C3 and C4, positive anti-Smith antibodies, and the presence of pericardial effusion
  • Two days after high-dose IV steroids were started, the pericardial effusion had become smaller
  • An echocardiogram at 6 months showed no pericardial effusion
  • Working with oncology, the team concluded that the positive markers were most likely false-positive results
  • Suspicion of malignancy was judged extremely low, and no further work-up was done
  • At one year the patient remained without symptoms and had a normal echocardiogram
  • Her lupus progressed over one year, with advanced lupus nephritis, and she then required stronger immunosuppressants (hydroxychloroquine and mycophenolate)
• The authors' conclusion: The authors hypothesized that this was a rare instance of false-positive malignancy (mesothelioma and adenocarcinoma) markers in the setting of lupus.

Topics

Medical terms in this study, explained in our Lexicon: Pericardial Effusion, Mesothelioma, Adenocarcinoma, Pericardial, Echocardiogram, Calretinin, Pleura, Pericardium.

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• Mesothelioma versus adenocarcinoma: false-positive CEA and Leu-M1 staining due to hyaluronic acid — J.A. Robb (1989)
• Systemic lymphadenopathy as the initial presentation of malignant mesothelioma: a report of three cases — Y. Zhang, Z.M. Taheri, et al. (2010)
• Identification of DAB2 and Intelectin-1 as Novel Positive Immunohistochemical Markers of Epithelioid Mesothelioma by Transcriptome Microarray Analysis for Its Differentiation From Pulmonary Adenocarcinoma — M. Kuraoka, V.J. Amatya, et al. (2017)
• Immunocytochemistry and DNA-image cytometry in diagnostic effusion cytology I. Prevalence of markers in tumour cell positive and negative smears — H. Motherby, M. Kube, et al. (1999)
• Occupational exposures and risk of systemic lupus erythematosus — C.G. Parks, G.S. Cooper (2005)

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