Lupus Pleurisy about a Case in the Pneumophthisiology Department of the Ignace Deen National Hospital of the Conakry University Hospital

Abstract

Introduction: Systemic lupus erythematosus (SLE) is a fairly common autoimmune disease that can affect all organs, including the lungs and pleura, and is the prototype of non-organ-specific autoimmune diseases. Worldwide, the prevalence of lupus is 4 - 178 per 100,000 inhabitants (Hbts), and an incidence of 0.3 - 23.7 per 100,000 Hbts/year. It is a disease of young women (sex ratio 1/9) (onset between 10 and 40 years). The black race is more affected. In Africa, an increase in the incidence of lupus erythematosus has been noted in recent years, a higher severity of the disease has also been postulated in the African population. In Sub-Saharan Africa, very few studies have been conducted on the epidemiological and clinical aspects of this disease. In Cameroon in a study by Yacouba et al . (2022), 108 patient files with neuropsychiatric involvement during systemic lupus erythematosus meeting the ACR 1997 criteria were included. In Benin, Zomalheto et al . in 2014, in their study carried out over 14 years from 2000 to 2013, had reported 33 cases of systemic lupus erythematosus. In Senegal, Ngaïdé et al . in 2016, in their series from February 14, 2011 to July 2, 2012, had found 50 cases of systemic lupus erythematosus. In Guinea, a study carried out by Sylla et al . in 2023 had reported 14 cases of SLE out of a total of 397 cases of systemic diseases. The interest of this study is that if before we spoke of pleurisy of tuberculous origin, pleurisy of cancerous origin, and pleurisy of cardiac origin, today, there is also lupus pleurisy due to systemic lupus erythematosus whose diagnosis and treatment is not easy. We report a case of systemic lupus erythematosus complicated by right pleurisy documented in the Pneumophthisiology Department of the Conakry University Hospital. Observation: Our observation represents the first case of lupus complicated by pleurisy, the particularity lies in the patient’s course and the persistent nature of the pleurisy despite corticosteroid therapy and a well-conducted pleural evacuation puncture. This was a 43-year-old patient, followed in internal medicine for polyarthralgia, fever, weight loss and in whom the diagnosis of systemic lupus erythematosus was made after the realization of positive antinuclear antibodies and the ACR 2019 criteria and treated with prednisolone (1 mg/kg) and Plaquenil (200 mg). After 4 months of treatment, without any respite, he received a pulmonology consultation for chest pain, dry cough and dyspnea at the slightest effort, where the diagnosis of lupus pleurisy was retained with a right pleurisy of average abundance and lemon yellow appearance associated with parenchymal infiltrates of the bases. The evolution was marked by an improvement in symptoms and a persistence of pleurisy despite medical treatment combined with pleural puncture. Conclusion: Systemic lupus erythematosus is often underdiagnosed due to insufficient technical platform in our context. Respiratory involvement is one of the frequent complications whose evolution is variable, hydrochloroquine and corticosteroids are treatments used in the management of systemic lupus in our African context, and in severe forms, it will be necessary to resort to immunopressants, which are not available in our countries.