B. Ilic*a (Dr), D. Marica (Dr), S. Popevica (Dr), M. Grujicb (Dr), A. Zecevicb (Dr)

a Faculty of Medicine, University of Belgrade, Clinic for Pulmonology, University Clinical Center of Serbia, Belgrade, SERBIA ; b Clinic for Pulmonology, University Clinical Center of Serbia, Belgrade, SERBIA

* ilicbranislav@yahoo.com

Introduction: Lymphocytic pleuritis most often occurs as a part of other diseases and conditions such as tuberculosis, malignancies, systemic connective tissue diseases or post-coronary artery bypass graft surgery. Diagnosis of pleural effusion often requires a multidisciplinary approach and diagnosis of idiopathic pleuritis is made only after the exclusion of all known etiological causes.

Case report: We present a case of a male patient, 46 years old, without previous chronic diseases, who came to our department due to a dry cough and increased fatigue that lasts for about 6 months. The chest X-ray showed bilateral pleural effusion, which was confirmed by MSCT of the chest, where massive bilateral pleural effusion, diffuse thickening of the parietal pleura and a small pericardial effusion were observed. Diagnostic thoracentesis initially obtained 1500 ml of serous effusion, biochemical characteristics of exudate, cytological findings are predominantly lymphocytes and mesothelial cells, no malignant cells were observed. Bacteriological and mycobacteriological analysis of effusion were negative. Extensive additional non-invasive diagnostics were then performed, which excluded immune disease, hematological/lymphoproliferative disease, tuberculosis. Bronchological examination excluded any pathological process in the tracheobronchial tree. A percutaneous biopsy of the parietal pleura was performed, followed by VATS thoracoscopy, and the pathohistological findings showed diffuse lymphocytic infiltration of the parietal pleura, excluded hematological disease and IgG4-related disease. Based on the performed diagnosis, it was concluded that it is most likely idiopathic lymphocytic pleuritis. Prednisone therapy was started with 40 mg daily with a gradual dose reduction. After 6 months of therapy there was a complete regression of pleural effusion, and the patient was referred to a regular control regimen.

Conclusion: Idiopathic lymphocytic pleuritis is a rare, immunosuppressant-responsive form of this disease and the diagnosis is made by excluding the known causes of this disease.

Disclosure of funding source(s): none