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Systemic lupus erythematosus presenting as right-sided massive pleural effusion with autoimmune hypothyroidism and medium vessel vasculopathy
  1. Baijaeek Sain1,2,
  2. Ritam Chakraborty3,
  3. Natalia Ghosh4 and
  4. Arpit Saha3
  1. 1Department of Trauma & Orthopaedics, Imperial College Healthcare NHS Trust, London, UK
  2. 2Department of General and Upper GI Surgery, Aneurin Bevan University Health Board, Newport, Wales, UK
  3. 3Department of Critical Care, AMRI Hospitals, Kolkata, West Bengal, India
  4. 4Department of Internal Medicine, KPC Medical College and Hospital, Jadavpur, West Bengal, India
  1. Correspondence to Dr Baijaeek Sain; baijaeek.sain{at}


Segmental involvement of medium-sized vessels are lesser-known manifestations of systemic lupus erythematosus (SLE) vasculopathy. Medium vessel vasculopathy and peripheral vascular disease (PVD) mimicking manifestations of SLE, although rare, have been reported, particularly in Asian women mostly under the age of 30 years. This is due to metabolic disadvantages in their ethnicity, with high incidence of insulin resistance and resulting metabolic syndrome, leading to lower high-density lipoprotein cholesterol levels, higher triglyceride levels and small dense low-density lipoprotein, increased proinflammatory cytokines, endothelial dysfunction and procoagulant tendency. Owing to the longer duration of the disease with the simultaneous use of steroids, vessels are often affected. SLE may also present with thyroid manifestations against a background of a proinflammatory immune state, where autoimmune thyroid diseases, such as Hashimoto’s thyroiditis, may coexist. Here, we describe the case of a young woman who presented with progressive shortness of breath, right leg pain and cough with amenorrhoea and was diagnosed with SLE.

  • Thyroiditis
  • Systemic lupus erythematosus
  • Vasculitis
  • Rheumatology

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  • Contributors BS: conceptualisation and drafting of the main manuscript. RC: supervised the manuscript and was the main consultant treating the patient. NG: drafting manuscript. AS: conceptualisation and review.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Case reports provide a valuable learning resource for the scientific community and can indicate areas of interest for future research. They should not be used in isolation to guide treatment choices or public health policy.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.