Article Text
Summary
Urinothorax, an unusual and rare cause of pleural effusion, is usually secondary to urinary obstruction and abdominal trauma. We describe an uncommon case of left-sided urinothorax in a 35-year-old man with diabetes and hypothyroidism associated with an autoimmune disorder without obvious obstructive uropathy. Workup revealed pancytopenia, mild proteinuria, positive anti-nuclear and anti-dsDNA antibodies suggestive of probable systemic lupus erythematosus. Contrast-enhanced CT-chest and abdomen showed hepatosplenomegaly with bilateral renal abscesses and a fistulous connection between left superior calyx and left the pleural cavity. Patient was initially managed by intravenous antibiotics, intercostal tube drainage and ipsilateral double-J stent placement. The definitive management in the form of closure of nephropleural fistula was achieved with sclerotherapy using 0.1% povidone-iodine instillation, while oral steroids were started for the probable autoimmune disorder. To the best of our knowledge, this is the first case of spontaneous non-obstructive nephropleural fistula associated with an autoimmune disorder, managed by minimally invasive methods.
- diabetes
- immunology
- proteinurea
- renal intervention
- systemic lupus erythematosus
Statistics from Altmetric.com
Footnotes
Contributors All of the authors declare that they have all participated in the design, execution and analysis of the paper, and that they have approved the final version. Individual author contribution is as follows: RA—Concept, design, supervision, processing, writing manuscript and critical analysis. SG—Concept, supervision, processing, writing manuscript and critical analysis. AG—Supervision, processing, writing manuscript and critical analysis. VK—Supervision, writing manuscript and critical analysis.
Competing interests None declared.
Patient consent Obtained.
Provenance and peer review Not commissioned; externally peer reviewed.