To the Editor:
Chronic pleural effusions are sometimes difficult to manage. Some cases remain unresolved despite invasive investigations. Iatrogenic pleural effusions are not rare but the diagnosis is mostly putative and difficult to ascertain. Herein, we report two cases of eosinophilic pleural effusions that are potentially iatrogenic and review the current literature accordingly.
A 38-yr-old male, nonsmoker has been followed for 13 yrs in the Dept of Neurology (AP-HM, Marseille, France) for treatment of multiple sclerosis. Until 2 yrs ago he had been treated with bolus of cyclophosphamide, and is currently being treated with 10 mg prednisolone per day, with significant neurological sequelae. His treatment includes prednisolone 10 mg q.d., dantrolene 100 mg t.i.d. (doubled 3 months ago), osomeprazole 20 mg q.d., fluoxetine 20 mg q.d. and paracetamol in case of pain.
1 month ago the patient noted chest pain and dyspnoea at rest with no other respiratory, extra-thoracic or general symptoms. Chest pain increased leading to hospitalisation in the Dept of Neurology. Clinical examination found no serious organ failure, fever or signs of respiratory distress; however, the pulmonary examination showed a pleural syndrome of the left hemi-thorax. The rest of the physical examination was unremarkable, taking into account the patient's pre-existing neurological sequelae. Laboratory tests showed leukocytosis with 85% of neutrophils without eosinophilia, C-reactive protein (CRP) of 15 mg·L−1, brain natriuretic peptide of 20 pg·mL−1 and normal hepatic, renal, thyroid and adrenal tests. The chest radiograph showed a left pleural effusion, right mediastinal deviation and a blunting of right costophrenic angle, without any associated parenchymal lesion. The computed tomography (CT) scan showed a large left pleural effusion, a small right pleural effusion and a moderate pericardial effusion. The CT scan did not show any parenchymal lesion, except a left lower lobe atelectasis in contact …