16 May 2023 : Case report
[In Press] Chocolate-Colored Pseudochylothorax in a Woman with a History of Pleuropulmonary Tuberculosis
Challenging differential diagnosis, Rare diseaseLaura Braga Monnerat 1ABEF, Elisa Barbosa Louzada1ABEF, Vanessa Godinho Souza Braga1ABEF, Mariana Soares da Cal 1ABEF, Agnaldo José Lopes 123ABEFG, Thiago Thomaz Mafort 12ABEF
Am J Case Rep In Press; DOI: 10.12659/AJCR.939473
Available online: 2023-05-16, In Press, Corrected Proof
Publication in the "In-Press" formula aims at speeding up the public availability of the pending manuscript while waiting for the final publication. The assigned DOI number is active and citable. The availability of the article in the Medline, PubMed and PMC databases as well as Web of Science will be obtained after the final publication according to the journal schedule
Pseudochylothorax is a rare entity, with only a few hundred case reports worldwide. It presents as a pleural effusion rich in lipids, typically with a cloudy, milky appearance. The diagnosis is made based on the levels of cholesterol and triglycerides in the pleural fluid.
This is the case report of a 55-year-old woman with a history of pleuropulmonary tuberculosis that was treated in childhood, with a new infection and treatment in adulthood that evolved to a left pleural effusion. Thirteen years after completing her last treatment for tuberculosis, the patient developed general fatigue and dyspnea on exertion. Computed tomography of the chest confirmed the presence of a pleural collection in the same location as in adolescence, suggesting a chronic evolution with encystation. The patient underwent ultrasound-guided diagnostic thoracentesis. The collected liquid was thick, chocolate-colored, with the following biochemical characteristics: pH, 7.3; glucose, 37.9 mg/dL; LDL, 2059.8 IU/L; total protein, 8.8 mg/dL; triglycerides, 90 mg/dL; adenosine deaminase, 56 U/L; and cholesterol, 300 mg/dL. The effusion was characterized as a pseudochylothorax. The cell count showed 631 000 leukocytes/µL, with 87.9% polymorphonuclear cells. Owing to the patient’s respiratory symptoms, an evacuatory thoracentesis was performed. After the procedure, the patient’s symptoms improved.
Although pseudochylothorax is a rare condition, its possibility must always be kept in mind to avoid the hazards of misdiagnosis. In addition to the ‘classic’ milky and machine oil appearance, a chocolate-colored appearance should also serve as a clue to the diagnosis of pseudochylothorax.
Keywords: Pleural Diseases; Pleural Effusion; Thoracentesis
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