A 54-year-old male presented with a 6-month history of dry cough, mild fever and night sweats. Two months before the admission, he was diagnosed with possible tuberculous pleuritis in the local clinic and was given triple anti-tuberculous treatment (isoniazid, rifampicin and ethambutol) for 2 months. But his conditions did not change evidently. There was no chest pain, haemoptysis or palpitation. He was a chronic smoker for over 30 packs per year. Physical examinations only showed decreased breath sound, sporadic rhonchi and moist rale in the bilateral lower hemithorax. He preferred in sitting position. The patient’s past history, social history, family history, and review of systems were otherwise unremarkable.
Examination
Blood investigations revealed the following values: white blood cell (WBC) count: 2.5×109/L (40.7% neutrophils, 46.2% lymphocytes, 8.5% monocytes, 1.7% basophils and 0.0% eosinophils); haemoglobin, 76 mg/L; platelet count, 137×109/L; total protein, 93.1 g/L; albumin, 27.2 g/L; globulin, 65.9 g/L; blood calcium, 1.82 mmol/L (2.25-2.75 mmol/L), uric acid, 454.0 µmol/L; erythrocyte sedimentation rate (ESR), 43 mm/h; carcinoembryonic antigen (CEA), carbohydrate antigen 19-9 (CA19-9) are in normal range; thrombin time (TT), 24.3 s; D-dimer, 0.55 ng/L; T-SPOT.TB was negative. The serum light chain kappa: 4,210 mg/dL; the serum light chain lambda: 58.4 mg/dL. The serum immunoglobulin A: 351.00 mg/L, M: 153.00 mg/L, G: 52.7 g/L
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