Recurrent pleural effusion in patient with liver cirrhosis – a case report

Liver cirrhosis is caused by necrosis of liver cells leading to fibrosis and nodule formation. Structural abnormalities of the liver causing impaired hepatocyte function and portal hypertension. Hepatic hydrothorax is a less common pulmonary complication of portal hypertension. We present a 47 years old man with liver cirrhosis and recurrent massive pleural effusion. Diagnosis can be challenging because it can be associated with pulmonary or systemic disorders. Pleural fluid analysis is necessary to differentiate transudate or exudate as the cause of pleural effusion. Thoracentesis is done to reduce the complaints experienced by the patient.

Granulomatous lung disease and immune reconstitution inflammatory syndrome in Whipple’s disease

We present the case of a 70-year-old woman with a history of seronegative arthritis, recurrent pleural effusion and weight loss. A prior lung biopsy had revealed non-caseating epithelioid cell granulomas without evidence for microbial organisms on special stains. Intestinal biopsy findings where suspicious for Whipple’s disease, which was confirmed by PCR testing, both on the intestinal and retrospectively on the lung tissue. Treatment with ceftriaxone resulted in clinical deterioration with fever, arthritis and recurrent pleuritis consistent with immune reconstitution inflammatory syndrome. Dose increase of glucocorticoids and therapy rotation to doxycycline and hydroxychloroquine resulted in rapid clinical improvement.

Multifocal pleural capillary hemangioma: a rare cause of hemorrhagic pleural effusion-case report

Background Capillary hemangioma can be found in many organs, but rarely in pleura. Previously, only localized pleural capillary hemangioma cases have been reported. Corticosteroids are the most commonly recommended drugs in capillary hemangioma. Case presentation Here, we present a case of a young woman with recurrent hemorrhagic pleural effusion. Despite repeatedly thoracentesis, the routine examinations, including chest computed tomography (CT) scan, pleural effusion biochemical test, and cytology all failed to make a definite diagnosis. Thus, single port video-assisted thoracoscopy (VATS) was then performed. Numerous nodules arising from the parietal pleura were found, and biopsies showed multifocal pleural capillary. However, recurrent pleural effusion was successfully managed by oral azathioprine, after failure of dexamethasone treatment. Conclusions To our knowledge, this is the first case of a patient with recurrent hemorrhagic pleural effusion masquerading as malignant pleurisy, but in fact caused by multifocal pleural capillary hemangioma.