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Updated: Sep 9, 2026

Imaging Features of Systemic Sclerosis-Associated Interstitial Lung Disease
Published on: June 16, 2020
Systemic sclerosis presenting as recurrent pericardial effusion despite repeatedly negative multiplex antinuclear
Tsubasa Omae1, Kazuya Nagao2, Sohei Funakoshi3
1Neurosurgery, Kyoto University Hospital, Kyoto, Japan tsubasa1027@kuhp.kyoto-u.ac.jp.
Abstract:
A woman in her 70s was admitted three times over 22 months with recurrent pericardial effusions. A multiplex antinuclear antibody (ANA) assay by chemiluminescent enzyme immunoassay, reported only as a combined index, was repeatedly negative. Reassessment with careful history revealed long-standing Raynaud's phenomenon and episodic abdominal bloating, prompting further evaluation for systemic sclerosis (SSc). Indirect immunofluorescence (IIF) on HEp-2 (human epithelial type 2) cells showed ANA positivity (fine speckled 1:640 and nucleolar 1:320) and ELISA detected anti-RNA polymerase III antibodies, confirming SSc. Because of pre-existing renal impairment and anti-RNA polymerase III positivity, glucocorticoids were avoided; colchicine 0.5 mg/day was started to prevent recurrence. No further pericardial effusion occurred during follow-up. This case illustrates that relying solely on a combined-index multiplex ANA screen can delay diagnosis and that HEp-2 IIF and disease-specific antibody testing are essential when clinical suspicion persists.
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