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Rheumatoid pleural effusion — SCE Respiratory MCQ

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ModeratePleural DiseaseRheumatoid pleural effusionSCE Respiratory

A 57-year-old woman with rheumatoid arthritis presents with dyspnoea and a unilateral pleural effusion. Pleural fluid is exudative with pH 7.14, glucose 1.2 mmol/L, LDH 1800 IU/L and negative cultures. CT shows no pleural nodularity and she is afebrile. What is the most likely diagnosis?

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Correct answer: B — Rheumatoid pleuritis

Rheumatoid pleural effusions can have very low glucose and pH with high LDH, mimicking infection. Mesothelioma remains a differential in unilateral effusion but CT lacks nodularity and the biochemical pattern with established rheumatoid disease is characteristic. Heart failure would be transudative, and chylothorax would have elevated triglycerides.

Reference: BTS Pleural Disease Guideline 2023