A 54-year-old male presented with a 6-month history of dry cough, mild fever and night sweat. Two months prior to the admission, he was diagnosed with possible tuberculous pleuritis in the local clinic and was given triple antitubercular 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 years.
Examination
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 system were otherwise unremarkable.
The pleural fluid was light yellow and highly cellular, in which 75% was mononuclear cells. Results from the analyses of the right side pleural fluid indicate an exudative type according to the Light criteria, which contained total protein 56.2 g/L, albumin 18.3 g/L, globulin 37.9 g/L, A/G 0.5, lactic dehydrogenase (LDH) 142.0 U/L, a-hydroxybutyrate dehydrogenase (aHBDH) 172.7 U/L, adenosine deaminase (ADA) 62.4 U/L. No acid-resistant bacilli were found. Computed tomography (CT) image of the chest (axial view) indicated bilateral sided pleural effusion and distinctive pleural nodular-like thickening. The posteroanterior skull radiographs demonstrated low craniofacial bones density, and a saccate transparent area could be seen without any signs of fractures.
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