A 50 year old male presented with fever, non productive cough of 2 weeks duration along with 6 kg weight loss in the last 1 month. CXR was s/o right sided moderate pleural effusion and diagnostic aspiration (20ml) showed amber coloured fluid (WBC 220, N20/L80, protein-3gm/dl, sugar -30gm/dl), which was negative for AFB and gram stain, along with negative Xpert M TB. HIV ELISA was positive. He was started on empiric ATT along with deflazacort and referred in view of persistent symptoms despite 3 weeks of ATT.
Examination revealed oral candidiasis. CXR showed a right sided moderate pleural effusion (fig.1) CD4 count was 40 (6%), HIV-1 VL was 20,00,000 and serum cryptococcal antigen was negative, Hb- 10, Wbc 3600, plt 140,000. USG thorax showed loculated pleural fluid with multiple septae ( fig2 ). Sspiration showed amber colored fluid (wbc 150 - N8/L92, sugar 18.4mg/dl, protein -2.3gm/dl). Gram, AFB and fungal stain of the fluid was negative and cytology showed no malignant cells.
Figure 1: CXR (PA) s/o right sided Pleural effusion Figure 2. USG right thorax s/o multiloculated effusion (red arrowsepta, yellow arrow-collapsed lung)
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