[Immunopathological syndrome with pleural and systemic localization observed in patients with endocavitary...

Four cases of recurrent pleural effusion that proved particularly resistant to medico-depletive management were observed in patients with intracavitary pacemakers. The picture included fever, high ESR, intense antismooth muscle antibody movement, serum and pleural liquid L.E. phenomenon and positive rheuma test, and mainly igG hypergammaglobulinaemia. The clinical and laboratory data suggested three pathogenetic explanations: 1) autoimmune disease secondary to surgical denaturation of myocardial, endocardial, venous or muscular autoantigens; 2) systemic autoimmune disease due to congenital or acquired instability of the immunological equilibrium; 3) pleural, monosymptomatic L.E. with delayed and dramatic clinical onset. Some practical considerations are expressed with respect to the syndrome and the position in the future.