Brucellosis: haemorrhagic pleural effusion

To describe haemorrhagic pleural effusion as a rare complication of brucellosis that finally needed lung decortication.

A 37-year-old female presented with a 1-week history of fever, dry cough and pleuritic chest pain. Physical examination showed signs of right pleural effusion and hepatosplenomegaly. Complete blood count showed pancytopenia, white blood cells 2.9/mm3, haemoglobin 10 g/dl, platelets 131/mm3. Chest X-ray confirmed a moderate right pleural effusion, that was found to be exudative biochemically. Culture of pleural fluid and blood grew Brucella species. Fever subsided with Brucella chemotherapy, but pleural effusion persisted. Computed tomographic (CT) chest scan showed a large loculated pleural effusion, which failed to resolve despite repeated aspirations under CT guidance. Fluid was always found to be haemorrhagic. Finally, lung decortication was done with successful outcome.

This case showed that brucellosis can cause haemorrhagic pleural effusion that needs lung decortication.