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.