Dr. Aratrika Das
Accumulation of excess fluid in pleural cavity is known as pleural effusion. It can be one-sided or may involve both sides. Bilateral effusion usually occurs in Congestive heart failure (CHF), renal failure, malignancy etc. Tuberculosis (TB) sometimes also lead to bilateral pleural effusion. In our case, a 53 years old male farmer developed chest pain on right side, shortness of breath, on & off high-grade fever without rigors and weakness. He has a protracted history of over 4-5 months and previously diagnosed with pleural effusion followed by pleural fluid aspiration which showed raised Adenosine Deaminase (ADA) and lymphocyte predominance. Further Chest X-ray (CXR) showed a large effusion on the right side. Aspiration & analysis of pleural fluid along with thoracoscopic biopsy & Gene Xpert studies confirmed the diagnosis of tuberculosis. The patient was started on anti-tubercular drugs (ATT) but developed left-sided effusion with a high fever within 2 days. The patient was put on low dose steroid with ATT which resolved the fever. Left-sided pleural fluid aspiration was done and pleural fluid showed similar biochemistry like the right-sided fluid.
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