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Pulmonary and Critical Care Pearls |

A 51-Year-Old Man with Fever, Ulnar Neuropathy, and Bilateral Pleural Effusions*

Akmal Sarwar, MD; Paul F. Dellaripa, MD; John F. Beamis, Jr., MD, FCCP
Author and Funding Information

*From the Section of Pulmonary and Critical Care Medicine (Drs. Beamis and Sarwar) and the Section of Rheumatology (Dr. Dellaripa), Lahey Clinic Medical Center, Burlington, MA.

Correspondence to: John F. Beamis, Jr., MD, Section of Pulmonary and Critical Care Medicine, Lahey Clinic Medical Center, 41 Mall Rd, Burlington, MA



Chest. 1999;116(4):1105-1107. doi:10.1378/chest.116.4.1105
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Extract

A 51 -year-old man was seen in October 1997 with fever, cough, and right-sided pleuritic chest pain. He also complained of arthralgia and numbness in the ulnar distribution of both hands. Radiography of the chest at that time revealed a right lower lobe infiltrate and a right pleural effusion. Right thoracentesis yielded an exudative pleural fluid. Pleural fluid cytology was unremarkable. Open thoracotomy and pleural biopsies revealed fibrosis, fibrin deposition, and acute and chronic inflammation. All cultures were negative. He gradually improved. However, his condition worsened again in December 1997. He was seen at a local hospital in January 1998 because of fevers, an 8-lb weight loss, and a large left pleural effusion. Thoracentesis was performed. The pleural fluid showed a total protein of 4.4 g/dL and lactate dehydrogenase of 2,672 IU/L. All cultures were negative. Antinuclear antibody and rheumatoid factor were negative both in serum and pleural fluid. The patient took cefuroxime and doxycycline for 1 week without any improvement.

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