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Abstract: The patient presented with left-sided chest pain with no clear cause 10 days ago, which was persistent and sharp, and gradually decreased after 5 days, but dyspnea appeared and gradually increased, accompanied by fever in the afternoon. After relevant examination, the patient was diagnosed with “tuberculous pleural effusion”, which is a relatively common type of pleural effusion in clinical practice. After active anti-treatment, the patient’s condition was controlled, and the symptoms of fever, dyspnea and chest pain were significantly reduced, and the pleural effusion gradually decreased.
Basic information】Male, 28 years old
Disease Type】Tuberculous pleural effusion
Hospital】The Second Hospital of Harbin Medical University
Time of consultation】November 2018
Treatment plan】Intramuscular injection (compound aminobarbital injection) + intravenous injection (levofloxacin hydrochloride injection) + oral medication (isoniazid tablets, rifampin capsules, pyrazinamide capsules, ethambutol hydrochloride tablets, liver protection tablets) + thoracic puncture and fluid extraction
[Treatment period] Hospitalization for 10 days, home medication for at least six months
Treatment effect】The patient’s fever, dyspnea and chest pain were significantly reduced, and the pleural effusion gradually decreased.
I. Initial consultation
The patient, male, 28 years old, came to the clinic because of dyspnea. He reported that 10 days ago he had left-sided chest pain without any clear cause, and the chest pain was persistent and sharp, and spread to the surrounding area, which was aggravated by deep inspiration and slightly reduced by left-sided lying. The body temperature was up to 38°C. The fever appeared in the afternoon and was most severe in the evening. The symptoms were not relieved after taking oral anti-inflammatory drugs at home, and the dyspnea gradually increased and the body temperature was difficult to drop. During the attack, he had decreased physical strength, loss of appetite, night sweats, red and yellow urine, constipated stools, and poor sleep. Pulmonary CT showed left pleural effusion, and the patient was admitted to our hospital with “left pleural effusion”.
Pulmonary CT
II. Treatment history
After admission, the patient was drained by thoracentesis and 600ml of straw yellow fluid was extracted. The routine pleural fluid: Rivalta (positive), cell count 1300×10^6/L, neutrophils 90%, lymphocytes 10%, no cancer cells were found in the exfoliated cells of the pleural fluid, T-SPOT.TB test showed positive for Mycobacterium tuberculosis, so the diagnosis of tuberculous pleural effusion caused by tuberculous exudative pleurisy was clear. The patient was first given compound aminobarbital injection intramuscularly to assist in reducing fever and levofloxacin hydrochloride injection intravenously for anti-inflammation. Subsequently, the patient was given isoniazid tablets, rifampin capsules, pyrazinamide capsules, and ethambutol hydrochloride tablets and liver protection tablets orally. Thoracentesis fluid was withdrawn 2-3 times a week until it could not be withdrawn, and the patient was advised to rest in bed with adequate protein, calories and vitamins.
III. Treatment effect
The patient was admitted to the hospital and after standard treatment, the symptoms of fever, dyspnea and chest pain were significantly reduced. After 5 days of thoracentesis and oral anti-tuberculosis medication, the fever subsided significantly and the pleural effusion was gradually reduced, and the patient was discharged from the hospital after 10 days of comprehensive hospitalization. The patient was advised to continue taking the above-mentioned anti-tuberculosis drugs orally for at least six months, during which time liver function, blood routine and chest X-ray were monitored.
IV. Notes
We are glad that the patient’s symptoms are gradually improving, but after discharge, we still need to advise the patient that anti-tuberculosis treatment is a long-term process, so he needs to strictly follow the doctor’s prescription for regular medication and the whole course of medication, and avoid increasing or decreasing the dosage or stopping the medication on his own to prevent the occurrence of drug-resistant tuberculosis pleural effusion. In general, you should exercise, eat more high-quality protein food, avoid spicy and stimulating food, quit smoking and drinking, and avoid staying up late and straining to avoid recurrence of pleural effusion due to low immune function.
V. Personal insight
Pleural effusion is a relatively common clinical disease, and the causes of pleural effusion are very many and complicated, most common causes are mycobacterium tuberculosis infection and tumor metastasis. This patient has pleural effusion caused by tuberculous exudative pleurisy. Even after discharge from the hospital, it is necessary to observe whether he has any abnormal symptoms and follow up regularly at the outpatient clinic. In addition, it is necessary to pay attention to the side effects of anti-tuberculosis drugs, regularly review liver and kidney functions, and if adverse drug reactions occur, go to the hospital promptly and have the type of drug or drug dose adjusted by a professional doctor.