In the emergency unit, 660 ml of straw-colored fluid was aspirated from
the right hemithorax and sent for laboratory analysis. She was admitted,
treated with oral antibiotics for possible bacterial pneumonia, started
on TB treatment with prednisone and a pigtail chest drain was inserted
to drain the pleural fluid.
Laboratory investigations showed a C-reactive protein of 239 mg/L, which
was significantly raised. The raised C-reactive protein was probably due
to the inflammatory response rather than superimposed bacterial
infection((1). The full blood count with a white cell count 12.86
x109/L (neutrophils 58 %, lymphocytes 28 %,
monocytes 12 %, eosinophils 1%), hemoglobin 12.4 g/dL and platelets
419 x 109/L. Pleural fluid was consistent with an
exudate: protein 59 g/L, adenosine deaminase 42.0 U/L, with lymphocyte
predominance: lymphocytes 856 /uL, polymorphs 5 /uL. Fluid was negative
by GeneXpert Ultra for M. tuberculosis and negative for bacteria
and TB culture. Surprisingly, a pale- pink cystic structure measuring 65
x 25 x 8 mm drained through the pigtail drain; histology showed a
degenerate cyst wall composed of oedematous villous-like projections and
comprising of an outer cuticular layer, middle cellular layer and inner
fibrillary layer, in keeping with a degenerate cysticercosis, Fig 2.
This cyst was probably located on lung surface or in pleura, hence the
result of pleural effusion.