A case of sparganosis with eosinophilic pleural effusion]

A 61 year-old man was admitted to our hospital complaining of exertional dyspnea and presented with left pleural effusion. Laboratory findings showed peripheral eosinophilia and a slightly elevated inflammatory reaction. Chest X-ray film and CT revealed left pleural effusion, but there were no particular abnormal findings on the lung fields. Pleural effusion was exudative, yellowish and contained numerous eosinophils. His detailed medical history showed that he had eaten uncooked snakes, which led us to suspect parasite diseases. Multiple-dot ELISA method was performed to detect specific anti-parasite antibody. The patient was diagnosed with sparganosis after the detection of a highly positive reaction against Spirometra erinacei-europaei in both serum and pleural effusion. Parasite disease is an important consideration on differential diagnosis of eosinophilic pleural effusion, and multiple-dot ELISA method might be helpful for screening it.     

A case of toxocariasis with eosinophilic pleural effusion

A 76-year-old man admitted for general malaise with fever was found in clinical examination on admission to have eosinophilic pleural effusion, peripheral eosinophilia, and a slightly elevated inflammatory reaction. Immunological examination, including microplate ELISA, showed a high titer of specific antibody against Toxocara canis in both the serum and pleural effusion. We started treatment using albendazole, and found inflammatory findings and serum IgE were ameliorated. Parasitic disease is an important consideration in the differential diagnosis of eosinophilic pleural effusion, and serology is useful in screening for this.     

A case of paragonimiasis Miyazakii with bilateral pleural and pericardial effusion]

A 38-year-old man was admitted to our hospital for further examination of bilateral pleural and pericardial effusion. He had complained of dyspnea on exertion occurring six months after ingestion of raw freshwater crabs, Patomon dehaani. X-ray films and CT scan of the chest taken on admission revealed massive bilateral pleural and pericardial effusion. High serum IgE level and eosinophilia were noted on laboratory examination. Antibody against Paragonimus Miyazakii antigen was detected in patient's serum as well as pleural and pericardial fluids by the Ouchterlony test. The patient was treated effectively by Bithionol.     

Chronic eosinophilic pneumonia presenting with recurrent massive bilateral pleural effusion : case report

We describe a rare case of a 29-year-old woman with chronic eosinophilic pneumonia (CEP) presenting with massive bilateral pleural effusion leading to respiratory failure, a complication that was not reported before with CEP. The patient was successfully managed with ventilatory support and steroid therapy. On long-term follow-up, she remained well, receiving a low maintenance dose of prednisone without evidence of relapse of the disease.     

Lung adenocarcinoma with eosinophilic pleural effusion: A case report

Rationale:Eosinophilic pleural effusion (EPE) is a rare phenomenon in which the etiological diagnosis remains a challenging issue; here, we present a patient who was eventually diagnosed with malignant EPE by parietal pleural biopsy.Patient concerns:The patient was a 73-year-old man with pulmonary tuberculosis who was taking isoniazid and rifampin; after 6 months, he had right-sided eosinophilic pleura, and histopathological examination of the parietal pleura revealed malignant cells from the lung.Diagnosis:Based on the parietal pleural biopsy, the patient was diagnosed with lung adenocarcinoma with ipsilateral pleural metastasis stage IVA.Interventions:The patient received a first-line systemic chemotherapy regimen (premetrexed and carboplatin).Outcomes:The patient received 2 cycles of chemotherapy, and based on the response evaluation criteria for solid tumors, he achieved partial response and the effusion disappeared.Lessons:This case presents a patient with tuberculosis who was suffering from an EPE, which was eventually diagnosed as malignant EPE based on histopathological examination through medical thoracoscopy, although multiple Thinprep cytology tests showed no evidence of malignancy, pleural biopsy is necessary to obtain an accurate etiology diagnosis.     

Propylthiouracil-associated eosinophilic pleural effusion: a case report

We describe an unusual case of a patient with eosinophilic pleural effusion (EPE) associated with long-term propylthiouracil (PTU) administration. A 43-year-old woman was admitted to our hospital after complaining of chest pain. She had had Graves' disease, which had been treated with PTU for 11 years. Right-sided pleural effusion was detected and the result of thoracentesis confirmed an EPE. The patient's detailed medical evaluation failed to reveal any other cause of EPE. PTU was terminated since it was thought to be the cause. Despite withdrawal of the medication, however, the pleural effusion persisted for 6 weeks, and steroid therapy was planned for 15 days in decreasing dosages. During the control visit 10 days after the initiation of steroid therapy, no pleural effusion was observed, and the steroid was discontinued. Rechallenge with PTU produced recurrent pleural effusion. Therapy with PTU was again terminated, and treatment with methimazole and a brief course of low-dose corticosteroids were begun. Chest radiography revealed disappearance of the effusion within 10 days and it did not recur during a 1-year follow-up. To our knowledge, there is only 1 other case in the English-language literature describing EPE caused by PTU. Our report is of particular importance because it describes the development of that disorder in the 11th year of PTU treatment. It also shows that steroid therapy can be effective in treating drug-induced EPE.     

A case of toxocariasis with eosinophil-rich pleural effusion]

A 68-yr-old man presented with fever, cough, and appetite loss. On admission, clinical examination revealed pleural effusion (with eosinophils accounting for 25% of the cellular component), eosinophilia, and mildly elevated liver enzymes. A diagnosis of toxocariasis was reached on the basis of a positive enzyme-linked immunosorbent assay for Toxocara canis, and the efficacy of steroid and tiabendazole. Typical thoracic involvement of toxocariasis causes cough, wheezing, transient infiltration shadows on the radiographs, and other symptoms of L?ffler's syndrome. The infiltration shadows reflect the migration of the larvae through the lung, which involves their breaking through the alveolar walls. We report a rare case of toxocariasis with thoracic and pleural involvement without transient pulmonary infiltrates.     

A case of refractory bilateral pleural effusion due to post-irradiation constrictive pericarditis

A 51-year-old woman suffering from dyspnoea and refractory bilateral pleural effusions is discussed. The effusion was characterized as a transudate and cardiac decompensation and renal insufficiency were initially suspected. Diuretic agents were not effective and the patient required bilateral chest water-sealed drainage tubes for 4 months, after exclusion of neoplastic infiltration, collagen disease and other cardiac disorders. On echocardiogram, cardiac function and other findings were almost normal, except for shortening of deceleration time in transmitral flow velocity. To evaluate the reduced diastolic compliance, cardiac catheterization was performed, and revealed an elevated pressure in the right ventricle with a dip-and-plateau pattern, and constrictive pericarditis was diagnosed. The hydrothorax resolved after pericardiectomy and symptoms were alleviated. Three and a half years after surgery, the patient is well and taking only oral diuretics. The underlying mechanism of cardiac disorder appears to have been mixed restriction and constriction due to irradiation of her chest for breast cancer 13 years ago. Because the echocardiogram was within normal limits, the diagnosis was delayed. Radiation-induced constrictive pericarditis should be considered if there is an unexplained transudate effusion with a normal echocardiogram.     

A presumptive case of toxocariasis associated with eosinophilic pleural effusion: case report and literature review

Human toxocariasis is a helminthozoonosis caused by Toxocara sp. Larval migration of the organism through the tissues can result in eosinophila associated with a broad spectrum of clinical manifestations. We report a case of eosinophilic pleural effusion and CD8 cell deficiency associated with Toxocara sp. The symptoms of this patient responded promptly to a nonsteroidal anti-inflammatory medication (naproxen). This is only the fourth reported case of a pleural effusion associated with Toxocara.     

A case of tuberculous peritonitis showing a rapid increase of bilateral pleural effusion

A 62-year-old man had been treated with INH, RFP, EB, and PZA for pulmonary tuberculosis. Six months after completing the treatment, he was admitted because of low grade fever and abdominal distension. His abdominal radiograph and CT showed ascites, which showed elevated ADA. He was diagnosed as tuberculous peritonitis, and treated with INH, RFP, and EB. Three days after starting treatment, the ascites abruptly disappeared, followed by bilateral pleural effusion and pulmonary edema. He was found to develop ARDS. His pleural fluid was removed and treated with steroid pulse therapy. In spite of improvement of dyspnea, general status gradually deteriorated and he died following two months and a half treatment. Ascites causing a marked increase in abdominal pressure in a patient with tuberculosis peritonitis might move into the thoracic cavity with an unknown mechanism, and the removal of ascites might be needed to prevent this phenomenon.     

Chronic eosinophilic pneumonia with pleural effusion.

The case history of a 77-year-old lady with chronic eosinophilic pneumonia is presented. The diagnosis was difficult due to the simultaneous presence of a pleural effusion and congestive heart failure. Radiological findings and treatment are discussed.     

Pulmonary anisakiasis presenting as eosinophilic pleural effusion

A 63-year-old man developed a pleural effusion with marked eosinophilia, which was more prominent in the pleural fluid than in the peripheral blood. The pleural effusion spontaneously disappeared 7 days after admission. A multiple dot enzyme-linked immunosorbent assay for anisakiasis was strongly positive for both the serum and pleural fluid. The serum IgG titre for Anisakis simplex gradually decreased over 7 months. It is suspected that Anisakis larvae can penetrate the alimentary canal, and then migrate into the pleural cavity through the diaphragm. Screening with a serological test is useful in the diagnosis of this condition; human pulmonary anisakiasis.     

A case of Sj?gren's syndrome with pleural effusion]

A 45-year-old woman was admitted to our hospital because of a fever. A round erythema was noted on the skin, suggesting collagen disease. Bilateral pleural effusion developed during hospitalization, and serum and pleural effusion were positive for antinuclear antibody, RA factor, anti-SS-A antibody, and anti-SS-B antibody. A diagnosis of Sj?gren's syndrome was made on the basis of reduced lacrimation and the histological findings in a biopsy specimen from the lip. The cells in the pleural effusion were predominantly lymphocytes, and so a pleural lesion associated with Sj?gren's syndrome was suspected, but reports of this condition have been scarce. Good therapeutic results were obtained by corticosteroid administration. Sj?gren's syndrome should be considered in the differential diagnosis of pleural effusion associated with collagen disease.     

A case of pulmonary Mycobacterium gordonae infection with pleural effusion]

A 65-year-old woman, treated with prednisolone (5 mg daily) for rheumatoid arthritis, visited our hospital because of right chest pain. Chest CT showed small nodular shadows in the right lung accompanied with right pleural effusion. A pulmonary Mycobacterium gordonae infection was diagnosed, since M. gordonae was identified twice from her sputum. She was treated with rifampicin, ethambutol and streptomycin for two months, and then streptomycin was replaced with clarithromycin. Three months after the initial treatment, M. gordonae was eradicated from her sputum. Pleural puncture revealed bloody, exudative, lymphocytotic pleural effusion, but no malignant cells were identified. Although pathological diagnosis by thoracoscopic pleural biopsy could not be performed, it is likely that the pleural effusion was associated with the pulmonary M. gordonae infection in the present case.     

嗜酸粒细胞性胸腔积液相关病因最新研究进展

许多病因均可导致嗜酸粒细胞性胸腔积液(EPE)的发生,如感染性疾病、肿瘤、医源性、药物性等.既往认为EPE提示肿瘤低风险,但新近研究表明EPE中肿瘤发生率较非EPE无明显差异,但高比例嗜酸粒细胞可能预示肿瘤发生率低.过去认为结核相关EPE发生率低,但在结核高发地区,结核性胸膜炎伴EPE患者并不少见.气体和(或)血液进入被认为是导致EPE的常见原因,但反复胸穿是否导致EPE高发,报道结果存在争议,需要进一步深入研究.特发性EPE中许多病因需要进一步深入探究.     

A case of multiple pleural cryptococcosis without pleural effusion

Pulmonary cryptococcosis is most likely to occur in immunocompromised patients. The radiological manifestations generally include pulmonary parenchymal lesions, namely, pulmonary nodules, cavitary lesions, and consolidation; thus, multiple pleural nodules are unusual presentation. Here, we report a woman who presented with multiple pleural cryptococcosis without pleural effusion. The patient had previously undergone surgery for stage II rectal cancer. In addition, she received 6 cycles of chemotherapy for follicular lymphoma. Computed tomography (CT) revealed multiple small nodules involving the pleura without pleural effusion, which suggested possible recurrence of rectal cancer or malignant lymphoma as pleural dissemination. Thoracoscopic examination was performed, and pleural cryptococcosis was diagnosed. Although pleural cryptococcosis without pleural effusion is extremely rare presentation, clinicians should consider it when an immunocompromised patient presents with multiple pleural nodules. Thoracoscopic exploration should be the best procedure for the definitive diagnosis of multiple pleural nodules.     

Hydatid cyst presenting as an eosinophilic pleural effusion

A 61-year-old woman presented with an eosinophilic pleural effusion, secondary to transdiaphragmatic intrapleural spread of an hepatic hydatid cyst. Right posterolateral thoracotomy and frenotomy revealed a loculated pleural effusion associated with a 10 x 8 cm hydatid cyst in the posterior segment of the liver. Hydatid disease should be included in the differential diagnosis of eosinophilic pleural effusions in endemic regions.