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POSTGRADUATE CLINICAL SECTION
Year : 2010  |  Volume : 5  |  Issue : 4  |  Page : 247-248
Nonresolving pleural effusion in an elderly woman: A case report


1 Department of Pulmonary Medicine, Chhatrapati Sahuji Maharaj Medical University, (erstwhile King George's Medical University), Lucknow, Uttar Pradesh, India
2 Department of Pathology, Chandra Dental College, Lucknow, Uttar Pradesh, India

Date of Submission21-Apr-2010
Date of Acceptance08-Jul-2010
Date of Web Publication7-Sep-2010

Correspondence Address:
R Garg
Department of Pulmonary Medicine, Chhatrapati Sahuji Maharaj Medical University, Uttar Pradesh, Lucknow 226 003
India
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DOI: 10.4103/1817-1737.69118

PMID: 20981187

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How to cite this article:
Garg R, Sodhi R, Jabeed P, Rastogi A. Nonresolving pleural effusion in an elderly woman: A case report. Ann Thorac Med 2010;5:247-8

How to cite this URL:
Garg R, Sodhi R, Jabeed P, Rastogi A. Nonresolving pleural effusion in an elderly woman: A case report. Ann Thorac Med [serial online] 2010 [cited 2020 Aug 4];5:247-8. Available from: http://www.thoracicmedicine.org/text.asp?2010/5/4/247/69118


A 70-year-old nondiabetic and nonsmoker woman from eastern district of Uttar Pradesh, India, was referred to our department as a case of right-sided pleural effusion cause? Tubercular. She was on antitubercular treatment (ATT) for the past one and a half month with no response in her complaints of fever, breathlessness, dry cough, and right-sided chest pain. At the time of presentation, she had low-grade continuous fever, breathlessness, and chest pain, which was in the lower part of the chest on the right side and increased on deep inspiration and coughing. On physical examination, she had reduced chest expansion, stony dull percussion, and reduced breath sounds on the right side. The rest of the examination was not contributory. Her repeat chest radiograph revealed right-sided pleural effusion [Figure 1]. She was investigated on the lines of nonresolving pleural effusion keeping the differential diagnosis of malignancy, collagen vascular disease, and tuberculosis in mind. Her routine blood investigations and biochemistry were within normal limits. The Mantoux test showed no induration. Three sputum specimens for acid fast bacilli were negative on direct smear examination. Antinuclear antibody and Antidouble stranded DNA antibody were not detected. Diagnostic thoracentesis revealed straw colored fluid. It was exudative (protein 4.2 g/dL and serum protein 7.0 g/dL) in nature with cytology showing 240 cells/mm 3 with lymphocytes 90%, eosinophils 05%, and neutrophils 05%. Adenosine deaminase of fluid had the value of 35.5 U/L (normal < 40 U/L). No acid fast bacilli or bacteria were seen on Ziehl-Neelsen and Gram stain, respectively. Polymerase chain reaction of fluid was negative for nontubercular mycobacterium and Mycobacterium tuberculosis. The pleural fluid was negative for malignant cells on four different occasions. During the examination of the fluid in the Neubauer chamber for the leukocyte count, our microbiologist noticed a single parasitic organism [Figure 2].
Figure 1 :Chest radiograph at the time of presentation

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Figure 2 :Microfilaria seen in pleural fluid cytology

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   References Top

1.Lymphatic filariasis: Fourth report of the WHO Expert Committee on filariasis. World Health Organ Tech Rep Ser 1984;702:3-112.  Back to cited text no. 1      
2.Arora VK, Gowrinath K. Pleural effusion due to lymphatic filariasis. Indian J Chest Dis Allied Sci 1994;36:159-61.  Back to cited text no. 2  [PUBMED]    
3.Menon B, Garg A, Kalra H, Sharma R. Microfilarial pleural effusion in a case of tropical pulmonary eosinophilia. Indian J Chest Dis Allied Sci 2008;50:241-3.  Back to cited text no. 3      
4.Agrawal J, Kapila K, Gaur A, Wali JP. Bancroftian filarial pleural effusion. Postgrad Med J 1993;69:869-70.  Back to cited text no. 4      
5.Boornazian JS, Fagan MJ. Tropical pulmonary eosinophilia associated with pleural effusions. Am J Trop Med Hyg 1985;34:473-5.  Back to cited text no. 5  [PUBMED]  [FULLTEXT]  
6.Marathe A, Handa V, Mehta GR, Mehta A, Shah PR. Early diagnosis of filarial pleural effusion. Indian J Med Microbiol 2003;21:207-8.  Back to cited text no. 6  [PUBMED]  Medknow Journal  
7.Arora BS, Kumar S, Mathur MD. Filariasis as a cause of pleural effusion. Indian J Pathol Microbiol 2000;43:491-2.  Back to cited text no. 7  [PUBMED]  Medknow Journal  


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  [Figure 1], [Figure 2], [Figure 3]

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