A man with pleural effusion and ascites

Our plain-English summary of A man with pleural effusion and ascites, by A. Li, L. Poon, K.L. Khoo, et al (Chest, 2015).

The study

• Authors: A. Li, L. Poon, K.L. Khoo, J.E. Seet, A.K. Sinha, P. Lee
• Journal: Chest
• Published: 2015;147(6):e208-e214
• Type of article: Case report
• Cited by: 2 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

A male lifelong nonsmoker aged 58 years with no prior asbestos exposure complained of gradual worsening breathlessness over 3 months. This was associated with abdominal and leg swelling and a 2-kg weight loss. He had no fever, night sweats, hemoptysis, joint pain, rash, abdominal pain, chest pain, or orthopnea. The patient had no recent travel or contact with pulmonary TB. He had stage I left-side testicular seminoma treated with left-sided radical orchidectomy 10 years previous and recently received a diagnosis of Child's B alcoholic liver cirrhosis. His hepatitis B and C screen result was normal.

In plain English

This article was a case report of one patient: a 58-year-old man, a lifelong nonsmoker, who according to the authors had no prior asbestos exposure. He had three months of worsening breathlessness with abdominal and leg swelling. A chest X-ray showed a massive fluid collection around the right lung (pleural effusion), and CT scans also showed fluid in the abdomen (ascites). The pleural fluid had an adenosine deaminase level of 250 U/L. Cells in the pleural and abdominal fluid were large lymphoid cells that stained positive for the B-cell markers CD20 and CD79A. A PET/CT scan showed uptake in the pleura and peritoneum without lymph node involvement. Tests for HIV, human herpesvirus 8 and Epstein-Barr virus were negative. The diagnosis was HHV8-negative primary effusion lymphoma, a type of lymphoma. The authors listed asbestos-related disease and mesothelioma among the possible causes when pleural effusion and ascites occur together. After one cycle of chemotherapy, the patient developed acute liver failure and died one month later. The authors concluded that this lymphoma is rare and presents as serositis without lymphadenopathy.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: Case report of a single patient, with a discussion of possible diagnoses
• Who was studied: One 58-year-old man who was a lifelong nonsmoker. He had alcoholic liver cirrhosis and had a testicular seminoma treated 10 years earlier. The authors were based at hospitals in Singapore. The article does not state the dates of care.
• Exposure: The authors state that the patient had no prior asbestos exposure. No other exposure was studied.
• Main results:
  • The chest radiograph showed a massive right-sided pleural effusion.
  • The patient's pleural fluid had an adenosine deaminase level of 250 U/L.
  • The patient's pleural and peritoneal fluid contained large lymphoid cells that stained positive for CD20 and CD79A.
  • The PET/CT scan showed enhancement of the pleura and peritoneum without lymph node involvement.
  • Tests for HIV, human herpesvirus 8 in the pleural fluid, and Epstein-Barr virus were negative.
  • The diagnosis was HHV8-negative primary effusion lymphoma.
  • The authors' table of possible causes of pleural effusion with ascites included asbestos/mesothelioma. In their text, they listed mesothelioma with peritoneal spread as another possible cause of PET uptake in both the pleura and peritoneum.
  • After one cycle of chemotherapy, the patient developed acute liver failure and died one month later.
• The authors' conclusion: The authors concluded that HIV- and HHV8-negative primary effusion lymphoma is rare and uniquely presents as serositis without lymphadenopathy.

Topics

The National Library of Medicine indexes this study under subjects our site covers: Pleural plaques and thickening.

Medical terms in this study, explained in our Lexicon: Pleural Effusion, Ascites, Asbestos Exposure, Hemoptysis, Orthopnea.

Related studies

• Recombinant human endostatin (endostar) decreased recurrent ascites, pleural fluid and ascitic VEGF in a case of advanced mesothelioma — X. Chen, Y. Liu, et al. (2012)
• A rare case of primary effusion lymphoma in HIV negative patient: Diagnostic challenges and literature review — P. Malik, S.N. Khader, et al. (2021)
• Metastatic peritoneal mesothelioma in the setting of recurrent ascites: a case report — V. Samedi, S. White, et al. (2010)
• Malignant mesotheliomas and chemotherapy — C.P. Karakousis, M. Seddiq, et al. (1980)
• Efficacy of cytoreductive surgery with hyperthermic intraperitoneal chemotherapy in the management of malignant ascites — R.W. Randle, K.R. Swett, et al. (2014)
• Ultrasonography in ascites — H.C. Yeh, B.S. Wolf (1977)

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