Does anyone have a suggestion for potential diagnosis for a young female patient with a persistent pleural effusion (transsudate, lymphocytes, macrophages no malignant cells, no bacteria)) after pleural pneumonia in october 2014 treated with cefuroxim, clarithromycin, amocicillin/combactam and levofloxacin. CRP-Levels undulating around 40mg/dl. No evidence for tuberculosis, hiv? Diagnostic for vasculitis/polyserositis negative.
Transudative pleural effusion: Hypothyrodism ,Amyloidosis, Sracoid, Meig;s: if common causes of Transudative pleural effusions are ruled out.
Rarely: Lymphangioleomyomatosis, Endometriosis, Yellw Nail
Another important finding in a transudative effusion remains unexplained : the elevated CRP levels which indictes Inflammation or infective cause of the effusion
You need to go for Contrast CT chest followed by thoracoscopic pleural biopsy for tissue diagnosis
I agree about thoracoscopic pleural biopsy or COPE bx if you have ruled out systemic disease, ppd & QFT ARE negative, and ADA< 40. But before invasive studies, would be helpful to know the details of 'Pleural pneumonia' in october. Please be sure repeat PPD or QFT are negative. if Positive, I rx for TB & defer other studies until observation on TB rx for a few months. Has sputum been examined for AFB?
In many reports of young females in the literature only after recurrent presentations for effusions was the underlying diagnosis of SLE made. CRP is often normal in active SLE and serositis is one of the few causes of an elevated CRP although this may be due to intercurrent infection. Immunodeficiency can also be evaluated for.
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