A Young Man With Hypereosinophilia and Pseudochylothorax

A 31-year-old man presented with a 2-month history of dry cough, progressive dyspnea, intermittent fever, and unintentional weight loss of 8 kg. He had no wheezing, hemoptysis, chest pain, palpitations, or skin rashes. He did not smoke and reported occasional alcohol intake. One year earlier, he had been diagnosed elsewhere with pleuro-pericardial TB based on an ultrasound showing right-sided pleural effusion, and 2-dimensional echocardiography showed pericardial effusion. Pleural fluid analysis showed a lymphocytic exudative pleural effusion with elevated adenosine deaminase levels (46 IU/mL). The patient received anti-tubercular therapy along with tapering corticosteroids, showing initial clinical improvement. He was employed as a soldier in the army, and his last posting was in northeast India, where he frequently consumed raw crabs pickled in alcohol. There was no other significant environmental history.