-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.