009. HOW TO DIAGNOSE AND MANAGE SEROSITIS: AN EVIDENCE-BASED PARADIGM

Abstract

Background: Inflammation of the pleura, pericardium or peritoneum is recognized as serositis. This is often associated with systemic illness and pyrexia. It can be precipitated by infection and patients may be treated empirically with antibiotics. However, inflammatory disorders may also present in this way, particularly when more than one organ is involved. METHODS: We have summarized case histories of four patients each of whom presented with serositis and in whom infection was excluded. Each case was due to different diseases and required very different treatment. RESULTS: The first patient had abdominal pain with ascites and a history of surgery for previous aseptic peritonitis. Urinary porphobilinogen was positive and she required treatment with HaemArginate for acute intermittent porphyria. The second patient presented breathless with fever and arthralgia. She had pleuropericardial effusions, positive ANA and antiphospholipid antibodies. She required rituximab for systemic lupus erythematosus. The third patient presented with arthralgia, multiorgan failure and serositis. Her evanescent rash and high ferritin supported our clinical diagnosis of Adult onset Still's disease. She received IV cyclophosphamide and methylprednisone, followed by oral immunosuppressives, to good effect. Our final patient had a history of recurrent pyrexia, myalgia and generalized pain affecting her chest and abdomen, with intracavitary effusions. She had undergone multiple inconclusive investigations but had a family history of similar presentations. She was successfully treated with colchicine for periodic fever syndrome. Conclusion: Serositis may be overlooked or undervalued in patients with recurrent thoracic or abdominal pain. There are a broad range of conditions that may present in this way and we have developed a diagnostic flow chart to guide clinicians in the diagnosis and management of these relatively rare but sometimes life threatening disorders.