A 42-year-old woman with systemic lupus erythematosus presents with acute onset dyspnea and bilateral pleural effusion. Pleural fluid analysis: protein 3.8 g/dL, LDH 180 IU/L (serum LDH 220 IU/L), glucose 90 mg/dL, ANA positive in fluid (1:320), and complement levels low in fluid. Light's criteria are met. What is the most appropriate initial treatment?
- A Anti-tubercular therapy
- B Oral prednisone ✓
- C Intravenous cyclophosphamide
- D Therapeutic thoracentesis
Correct answer: B. Oral prednisone
Explanation
This is lupus pleuritis, the most common pulmonary manifestation of SLE. Pleural fluid shows exudative effusion with positive ANA, low complement, and low glucose in some cases. First-line treatment is oral corticosteroids (prednisone 0.5-1 mg/kg), which typically produces rapid response. Anti-TB therapy is not indicated without microbiological evidence. Cyclophosphamide is reserved for severe organ-threatening disease. Therapeutic thoracentesis alone does not treat the underlying inflammation.
Reference: Harrison's Principles of Internal Medicine, 21st ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
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