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All correspondence should be sent to: Junpei Saito, MD, PhD., Department of Pulmonary Medicine, School of Medicine, Fukushima Medical University, Hikarigaoka-1, Fukushima 960-1295, Japan, Tel: +81-24-547-1360, Fax: +81-24-548-9366
A 78-year-old man was admitted with a 2-year history of periodic fever of unknown
etiology with frequent remissions and exacerbations of pericardial and pleural effusions.
He had a history of tuberculosis at 22 years of age, and had no relevant family history.
Chest radiography (CX-R) demonstrated cardiomegaly and left-sided pleural effusion
(Figure 1A). Chest computed tomography revealed extensive pericardial effusion and left encapsulated
pleural effusion (Figure 1B). Oxygen saturation was 92% on 2 L/min of oxygen. Based on the available clinical
and radiological findings, the differential diagnosis encompassed malignant lymphoma,
tuberculosis pleuropericarditis, collagen diseases, and autoinflammatory disorders
such as familial Mediterranean fever.
Figure 1(A) Chest radiography on admission showed cardiomegaly and left-sided pleural effusion.
(B) Chest CT on admission showed pericardial effusion and predominantly left-sided
encapsulated pleural effusion. (C) Chest radiography after a week of admission. Progression
of cardiomegaly and bilateral pleural effusion were observed. (D) The results of Mediterranean
fever gene analysis in the present case and a healthy control (wild type). In the
present case, a C to G transition in codon 165 and a C to T transition in codon 314
were detected. (E) Chest radiography after the initiation of treatment with colchicine.
Cardiomegaly and bilateral pleural effusion were dramatically improved. (F) Chest
CT after the initiation of treatment with colchicine showed dramatic improvement of
pericardial and bilateral pleural effusions.
Conflict of interest: All authors declared no conflict of interest.
Authorship: All authors examined and treated the patient as one team, equally contributed to writing the manuscript, and had access to clinical information relevant to the described case.
