A 44-year-old woman was admitted to our hospital in July 2019 due to cough, sputum production, and chest pain lasting for one week. Chest computed tomography showed pulmonary infection, bilateral pleural effusions, and left pleural hypertrophy (Figure 1).
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The initial complete blood count revealed: white blood cell (WBC) count 21.5 × 109/L (22.7% monocytes, 65% neutrophils, 8.1% lymphocytes), haemoglobin 132 g/L, and platelet 233 × 109/L. C-reactive protein level was 13.1 mg/L (0–10 mg/L). The patient received antibiotics; however, her clinical symptoms did not improve, and the WBC count increased to 22.3 × 109/L with 26.9% monocytes, while no blasts were observed. The pleural effusion was bloody. Thoracocentesis indicated exudative effusion with 47 g/dL total protein, 277 U/L lactate dehydrogenase, and 7.37 mg/dL glucose concentration. The Rivalta test was positive, with a nucleated cell count of 12,800/μL, red blood cell count of 4800/μL (the ratio of red blood cells to nucleated cells was lower than that of the peripheral blood), and 86% of macrophages.
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