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Curious case of the unexplained exudative pleural effusion
  1. Phyoe Kyaw Pyae1,
  2. Rigers Cama1,
  3. Andrew G Nicholson2 and
  4. Rama Vancheeswaran1
  1. 1Respiratory Medicine, West Hertfordshire Hospitals NHS Trust, Watford, UK
  2. 2Department of Histopathology, Royal Brompton and Harefield NHS Trust, London, UK
  1. Correspondence to Dr Phyoe Kyaw Pyae; phyoe.pyae{at}


We report a case of a 74-year-old male patient who was referred to the respiratory clinic with an incidental finding of a left sided pleural effusion. He was initially being treated by the general practitioner for chest infection with productive cough that had limited resolution after course of oral antibiotics. At the pleural clinic, 1.5 L of serosanguineous fluid was drained and sent for diagnostics. However, the diagnosis only reached as far as idiopathic exudative effusion with lymphocytes and plasma cells. He was then referred for video-assisted thoracoscopic surgery pleural biopsy and pleurodesis. It revealed black pleura with abundant IgG4 positive cells. He is followed up in respiratory clinic where further discussion and treatment has commenced.

  • respiratory medicine
  • pathology

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  • Contributors Patient was seen in RV’s clinic. VATS pleural biopsy and histology slides were obtained and added by AGN. PKP and RC prepared the manuscript with RV’s supervision and reviewed by both RV and AGN. All authors approved the final manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.