PT - JOURNAL ARTICLE AU - Yasuyuki Kamata AU - Seiji Minota TI - Successful treatment of massive intractable pericardial effusion in a patient with systemic lupus erythematosus with tocilizumab AID - 10.1136/bcr-2012-007834 DP - 2012 Dec 21 TA - BMJ Case Reports PG - bcr2012007834 VI - 2012 4099 - http://casereports.bmj.com/content/2012/bcr-2012-007834.short 4100 - http://casereports.bmj.com/content/2012/bcr-2012-007834.full AB - A 51-year-old Japanese woman developed systemic lupus erythematosus (SLE) in 1995. In August 2005, she had massive pericardial effusion due to lupus pericarditis, which was compromising her circulation. Methylprednisolone pulse, intravenous cyclophosphamide pulse and pericardiocentesis were all ineffective. The pericardium was cut surgically to create a passage to drain the liquid into the pleural cavity. The procedure was temporarily effective; however, massive liquid accumulated in the pleural cavity within 1 year. Oral tacrolimus and topical betamethasone injection were ineffective. Since the interleukin-6 (IL-6) level in the effusion was markedly increased (1160 pg/ml), tocilizumab was administered intravenously at a dose of 8 mg/kg every 4 weeks. The effect was astonishing and only a residual amount of pericardial effusion remained. Prednisolone was tapered successfully from 15 to 5 mg daily. Tocilizumab is a treatment of choice when we confront an intractable serositis with massive effusion in SLE, if the IL-6 level is high.