Cholesterol pleurisy: a rare complication of tuberculosis

Abstract

Pseudochylothorax (PCT) is a rare form of pleural effusion and is characterized by high cholesterol content and milky pleural fluid. Common causes include tuberculosis, rheumatoid arthritis, paragonimiasis, echinococcosis and neoplasia. A 27-year-old male presented with breathlessness for past 3 years aggravated for past 2 months, swelling in perianal region for 6 months with history of treatment for pulmonary tuberculosis with recurrent left pleural effusion for which intercostal drain (ICD) was inserted. Blood investigations showed elevated total leukocyte count and ESR. Radiological investigations showed left loculated pleural effusion causing passive collapse of left lower lobe. Pleural fluid aspirated was milky white effusion following which ICD was inserted. Pleural fluid analysis showed a lymphocyte predominant, ADA-94 mg/dl, cholesterol-250 mg/dl, triglycerides 50 mg/dl and CHOL/TG ratio 5 indicating a PCT. Patient was initiated on Anti tuberculous therapy. After 2 months of ATT patient underwent left thoracotomy and decortication. Here we report a case of cholesterol pleurisy due to long standing tubercular effusion which is a rare manifestation of reactivation tuberculosis.