04 May 2025
: Case report 
Refractory Pleuritis in a Patient with Silicosis, Systemic Sclerosis, and Sjögren’s Syndrome: Considering the Potential Role of Adjuvant-Induced Autoimmunity
Challenging differential diagnosis, Unusual or unexpected effect of treatment, Rare coexistence of disease or pathology
Julia Morimoto ABCDEF 1, Yasuhito Suzuki ABCDEF 1*, Ryuichi Togawa BDE 1, Natsumi Watanabe BDE 1, Takahiro Kumanaka BDE 1, Ryutaro Tanaka BDE 1, Kentaro Kazama BDE 1, Koshi Saito BDE 1, Rina Harigane BDE 1, Ryuki Yamada BDE 1, Riko Sato BDE 1, Hikaru Tomita BDE 1, Takashi Umeda BDE 1, Mami Rikimaru BDE 1, Yuki Sato BDE 1, Hiroyuki Minemura BDE 1, Takefumi Nikaido BDE 1, Junpei Saito
BDEF 1, Kenya Kanazawa B 1, Xintao Wang BDE 1, Yoshinori Tanino BDE 1, Yoko Shibata ABDE 1
DOI: 10.12659/AJCR.947856
Am J Case Rep 2025; 26:e947856
Table 1 Laboratory findings on admission.
| Hematology | ||
|---|---|---|
| White blood cell | 5700 | /μL |
| Neutrophils | 81 | % |
| Lymphocytes | 13 | % |
| Monocytes | 4 | % |
| Eosinophils | 1 | % |
| Red blood cells | 394 | ×10/μL |
| Hemoglobin | 10.8 | g/dL |
| Hematocrit | 33.2 | % |
| Platelets | 42.6 | ×10/μL |
| PT | 71.3 | |
| PT-INR | 1.22 | |
| APTT | 38.6 | s |
| Fibrinogen | 379 | mg/dL |
| D-dimer | 2.1 | μg/mL |
| IgG | 2097 | mg/dL |
| IgA | 244 | mg/dL |
| IgM | 53 | mg/dL |
| IgE | 38 | IU/mL |
| Total protein | 6.2 | g/dL |
| Albumin | 2.1 | g/dL |
| AST | 27 | U/L |
| ALT | 19 | U/L |
| LDH | 341 | U/L |
| Total bilirubin | 0.4 | mg/dL |
| BUN | 14 | mg/dL |
| Creatinine | 0.81 | mg/dL |
| Na | 136 | mEq/L |
| K | 4.1 | mEq/L |
| Cl | 102 | mEq/L |
| CRP | 5.6 | mg/dL |
| BNP | 11.7 | pg/mL |
| Ferritin | 1655 | ng/dL |
| s-IL2 receptor | 824 | U/mL |
| KL-6 | 449 | U/mL |
| SP-D | 57.2 | ng/mL |
| Antinuclear antibody | 2560 | fold |
| SS-A antibody | >240 | U/mL |
| SS-B antibody | 6.2 | U/mL |
| scleroderma-70 antibody | >240 | U/mL |
| centromere antibody | 0.5 | U/mL |
| CCP antibody | <0.5 | U/mL |
| ARS antibody | <5.0 | |
| PR-3 ANCA | <1.0 | U/mL |
| MPO-ANCA | <1.0 | U/mL |
| Biological test | ||
| β-D glucan | <6.0 | pg/mL |
| T-SPOT (IGRA) | (−) | |
| MAC antibody | <0.5 | U/mL |
| BALF findings (right B) | ||
| Recovery rate | 85/150 (57) | mL (%) |
| Total cell count | 13.06 | ×10/mlBALF |
| Macrophages | 72.4 | % |
| Lymphocytes | 22.7 | % |
| Neutrophils | 4.5 | % |
| Eosinophils | 0.3 | % |
| CD4/CD8 ratio | 0.1 | |
| Bacterial culture | Negative | |
| Acid-fast bacillus culture | Negative | |
| APTT – activated partial thromboplastin time; ARS – aminoacyl-tRNA synthetase; AST – aspartate aminotransferase; ALT – alanine aminotransferase, BALF – bronchoalveolar lavage fluid; BNP – brain natriuretic peptide; BUN – blood urea nitrogen; CCP – cyclic citrullinated peptide; CRP – C-reactive protein; IgA – immunoglobulin A; IgE – immunoglobulin E; IgG – immunoglobulin G; IgM – immunoglobulin M; IGRA – interferon-gamma release assay; KL-6 – krebs von den lungen-6; LDH – lactate dehydrogenase; MAC – mycobacterium avium complex; MPO-ANCA – myeloperoxidase anti-neutrophil cytoplasmic antibody; PR3-ANCA – proteinase 3 anti-neutrophil cytoplasmic antibody; PT – prothrombin time; PT-INR – prothrombin time-international normalized ratio; s-IL2 – soluble interleukin-2; SP-D – surfactant protein-D. | ||