Cryptococcal pleural infection in a recurrent pleural effusion: a case report

We describe a 38‐year‐old male who presented with a lymphocytic exudative right pleural effusion and a raised pleural fluid adenosine deaminase (ADA) level. He was initially treated for pleural tuberculosis, but presented again with worsening pleural effusion 6 weeks later. A thoracoscopic pleural biopsy revealed chronic nodular granulomatous pleuritis with cryptococcal organisms present. The repeat pleural fluid culture was positive for Cryptococcus neoformans. He was started on intravenous amphotericin B and oral flucytosine for 1 week, and then continued on oral fluconazole. He was subsequently diagnosed to have acute myeloid leukaemia. His peripheral blood film showed presence of blast cells (33%), with flow cytometry showing increased myeloblast population. Lymphocytic exudative pleural effusions with raised ADA levels in an immunocompromised patient can be due to opportunistic fungal infections. Recurrent lymphocytic exudative pleural effusion in a previously well young male diagnosed to have cryptococcal pleural infection on thoracoscopic pleural biopsy, treated with intravenous amphotericin and flucytosine, and oral fluconazole. He was subsequently found to have acute myeloid leukaemia and underwent chemotherapy and bone marrow transplantation.
Source: Respirology Case Reports - Category: Respiratory Medicine Authors: Tags: Case Report Source Type: research