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Letter to the Editor
Reply
Respuesta
Lucía Ferreiroa, María Elena Toubesa, Luis Valdésa,b,
Corresponding author
luis.valdes.cuadrado@sergas.es

Corresponding author.
a Servicio de Neumología, Complejo Hospitalario Clínico-Universitario de Santiago, Santiago de Compostela, La Coruña, Spain
b Grupo Interdisciplinar de Investigación en Neumología, Instituto de Investigaciones Sanitarias de Santiago (IDIS), Santiago de Compostela, La Coruña, Spain
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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Callejas et al&#46; commented on the value of determining antinuclear antibodies &#40;ANA&#41; in pleural fluid for the diagnosis of pleural effusion &#40;PE&#41; of lupus origin&#44; an aspect that we could not further explore in our article because of space limitations&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">In this disease&#44; pleurisy is the result of a localized immune inflammation process with activation of the complement system and production of immune complexes&#46; PE behaves as typical exudates with high levels of protein &#40;&#62;3&#46;5<span class="elsevierStyleHsp" style=""></span>g&#47;dl&#41; and LDH &#40;<span class="elsevierStyleMonospace">&#60;</span>500<span class="elsevierStyleHsp" style=""></span>U&#47;l&#41;&#59; leukocyte count ranges from 500 to 15&#44;000<span class="elsevierStyleHsp" style=""></span>&#956;1 and the predominance of nucleated cells may be either lymphocytes or polymorphonuclear&#46; The glucose concentration is usually low and the pH is usually greater than 7&#46;30&#46;<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">1</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">The findings of low complement levels and high levels of ANA titers &#40;&#62;1&#47;160&#41; are suggestive of&#44; but do not diagnose&#44; lupus exudate<a class="elsevierStyleCrossRefs" href="#bib0050"><span class="elsevierStyleSup">2&#8211;4</span></a> as some neoplastic effusions&#44; particularly lymphomas&#44; may occur with high titers&#46;<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">5</span></a> Porcel et al&#46; show that the determination of ANA in pleural fluid does not add information to that of its determination in serum&#44; and its determination is only advised in patients with lupus and a PE of uncertain etiology&#44; since the absence of ANA in the liquid would go against the diagnosis of lupus pleuritis&#46;<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">6</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">Conversely&#44; the presence of lupus erythematosus &#40;LE&#41; cells is highly specific&#44;<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">7</span></a> although this test is rarely carried out due to the long preparation time it requires&#46;<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">8</span></a></p></span>"
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