Massive Right Chylothorax Secondary to a Severe Systemic Lupus Erythematosus Flare With Secondary Evans Syndrome: A Case Report and Literature Review.

This case report describes a 23-year-old male patient who presented with right chylothorax as the initial manifestation of a severe flare of systemic lupus erythematosus (SLE) and secondary Evans syndrome. Chylothorax and chylous ascites are rare features of SLE that can occur due to the accumulation of triglyceride-rich fluid in serous cavities. However, they have never been reported as the initial manifestation of a lupus flare. Evans syndrome is a rare disease characterized by autoimmune hemolytic anemia and immune thrombocytopenia, which can be secondary to SLE. The concomitant occurrence of both chylothorax and Evans syndrome in the setting of systemic lupus erythematosus has never been described, and the exact causative mechanisms of both entities are yet to be fully understood. In this report, we discuss our approach to this challenging case to broaden the understanding of the clinical manifestations of systemic lupus erythematosus. Our findings emphasize the importance of considering rare features of systemic lupus erythematosus and secondary diseases when evaluating patients with the disease.

Una neumonía complicada por un germen inusual: Reporte de caso / A pneumonia complicated by an unusual germ: Case report

Resumen El Streptococcus pseudoporcinus es un germen de la clasificación Beta hemolítico, con similitud a Streptococcus agalactiae, con baja incidencia en producción de infección pero principalmente aislado en tracto genitourinario de mujeres embarazadas y relacionado con complicaciones materno-fetales. Reportes en la literatura como infección fuera de este sitio son inusuales, por lo cual presentamos un caso de un hombre de 48 años con infección de tracto respiratorio bajo, compatible con colección neumónica y un derrame paraneumonico complicado, con requerimiento de manejo antibiótico y drenaje por toracostomia. Al realizar el estudio microbiológico se reportó aislamiento de un Streptococcus pseudoporcinus. No hay reportes previos en la literatura como causa de infección en este sitio anatómico.

Abstract Streptococcus pseudoporcinus in a germ of the Beta hemolytic group, similar to Streptococcus agalactiae, with low incidence in the production of infection, and isolated in most of cases from the genitourinary tract of pregnant women and related to maternal and fetal complications; the reports in the literature as infection outside this site are unusual. We describe a case of one 48-year-old man with a low respiratory tract infection with a pneumonic collection and a complicated parapneumonic effusion, requiring antibiotic management and thoracostomy drainage. Isolation of a Streptococcus pseudoporcinus. There is no report in the literatura as a cause of infection in this anatomical site.