A 44-year-old woman was admitted to our hospital in July 2019 due to cough, sputum production, and chest pain lasting for 1 week. Chest computed tomography showed pulmonary infection, bilateral pleural effusions, and left pleural hypertrophy. 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.
Examination
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. The cytology revealed no malignant cells, but 0.7% of blasts were detected by the flow cytometer. Microbial screening culture identified no organisms. The chest pain improved after thoracocentesis; nevertheless, severe chest pain recurred after 5 days of thoracocentesis. Subsequently, the pleural biopsy was performed under thoracoscopy. Extensive pleural adhesions were found in the patient. Postoperative histopathology confirmed heterotypic mononuclear cell infiltration in fibrous adipose tissue, with a few lymphocytes, plasma cells and neutrophils.
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