A Girl with Recurrent Pleural Effusion: Immunological Rebound or Isoniazid Induced Lupus?

Sir, U pleural e f fus ions are common secondary to Mycobacterium tuberculosis infection in developing countries. However, new onset pleural effusion after start of anti-tuberculous therapy or recurrent pleural effusions are rare occurrences. We, hereby, present a young girl diagnosed to have tuberculous effusion developed recurrent pleural effusion on initiation of therapy and raised the possibility of other aetiology of pleural effusion. A 16 year old girl presented with a week long history of fever with chills, malaise, anorexia, dyspnoea and left sided pleuritic chest pain. She had no past history of tuberculosis in her or history of any other s ignif icant chronic illness in family. On admission she had following vitals: pulse 126/ min; b lood pressure 96/70 mmHg; temperature 100.6°F; respiratory rate 24/min. Her oxygen saturation at room air was 99% by pulse oximetry. The general examination was unremarkable except mild pallor. Chest examination revealed reduced chest movements, s tony dul l note and absent breath sounds on left infrascapular region. Her haematological and biochemical profiles were within normal limits. Chest radiograph showed presence of pleural effusion on left side (Figure l). Computed tomography of thorax was done to rule out any pneumonitis or space occupying lesion in the lung parenchyma. After hospitalisation, thoracocentesis was done and 600 ml straw colour fluid was aspirated out (F igure 2 ) . The pleural fluid had pH 7.2,total leucocyte count 4600/cmm, polymorphs 12% and lymphocytes 88%, Proteins 5.6 gm/dl, lactic dehydrogenase 872 IU and glucose 14 mg/dl. Pleural fluid was negative for acid fast bacilli and gram staining. A Girl with Recurrent Pleural Effusion : Immunological Rebound or Isoniazid Induced Lupus?