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Curious case of the unexplained exudative pleural effusion
Phyoe Kyaw Pyae1, Rigers Cama2, Andrew G Nicholson3
1Respiratory Medicine, West Hertfordshire Hospitals NHS Trust, Watford, UK phyoe.pyae@nhs.net.
BMJ Case Reports
|September 21, 2021
Summary
A case study highlights an incidental pleural effusion in a 74-year-old male, initially treated as infection. Further investigation revealed a rare IgG4-related condition affecting the pleura.
Area of Science:
- Pulmonology
- Immunology
- Pathology
Background:
- A 74-year-old male presented with a persistent cough and incidental left-sided pleural effusion.
- Initial treatment for presumed chest infection with antibiotics showed limited efficacy.
Observation:
- A significant volume (1.5 L) of serosanguineous pleural fluid was drained.
- Diagnostic workup initially yielded an idiopathic exudative effusion with lymphocytes and plasma cells.
Findings:
- Video-assisted thoracoscopic surgery revealed a black pleura.
- Pleural biopsy demonstrated abundant immunoglobulin G4 (IgG4) positive cells, indicating a potential IgG4-related condition.
Implications:
- This case underscores the importance of thorough investigation for unexplained pleural effusions.
- Identification of IgG4 positive cells suggests a possible IgG4-related pleuritis, necessitating further evaluation and tailored treatment strategies.
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