A 48 y old woman with unremarkable medical history was admitted with bilate
ral pleural effusions; even though the fluid was drained, it re-accumulated
and necessitated many repeated drainages in the following 2.5 y (56 hospit
alisations). The patient underwent an extensive diagnostic work-up that dis
closed elevated serum antinuclear antibodies, serum anti-dsDNA antibodies,
pleural fluid anti-dsDNA and decreased pleural fluid C3 and C4. During that
period she has been treated with a variety of immunomodulating agents, sev
eral pleural talcage and pleurectomy, without any apparent response. Therea
fter, she received six courses of IVIg (2 g/kg body weight) in monthly inte
rvals, followed by four months treatment with cyclosporin. This treatment r
esulted in gradual and eventually complete disappearance of the pleural eff
usion, and now after more than 2 y the patient is free of symptoms and rece
ives no further medications.