Pleurisy, Fever, and Rapidly Progressive Pleural Effusion in a Healthy, 29-Year-Old Physician

  • John L. Johnson
    Correspondence to: John L. Johnson, MD, FCCP, Associate Professor of Medicine, Case Western Reserve University, School of Medicine, Room E-202, Tuberculosis Research Unit, 10900 Euclid Ave, Cleveland, OH 44106-4984
    From the Division of Infectious Diseases, Case Western Reserve University and University Hospitals of Cleveland, Cleveland, OH
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      A 29-year-old male physician presented with pleuritic chest pain and fever of 5 days' duration. He was in excellent general health and ran 6 to 8 miles daily. Two weeks previously, he had a 1-day viral syndrome, with fatigue, headache, rhinorrhea, and fever. He recovered fully; however, 6 days prior to hospital admission, he developed a temperature to 38.9°C, chills, and diffuse myalgias. He was awakened the next morning by severe right pleuritic chest pain. He saw his primary-care physician the same day. Findings on chest examination and a chest radiograph were normal. The total WBC count was 6.6 × 10 3/μμL. Erythromycin was prescribed but was not taken. Over the next 3 days, the fever and chest pain progressed and the patient returned to his physician. At that time, he was tachypneic with severe splinting of the right chest. A chest radiograph showed a small right pleural effusion ( Fig 1). He was treated with oral erythromycin and analgesics. The chest pain worsened over the next 6 h, and he was admitted to hospital. The patient was initially treated for community-acquired pneumonia with cefuroxime and erythromycin, and he received opiates for analgesia.
      Figure thumbnail gr1
      Figure 1 Posteroanterior chest radiograph obtained at hospital admission showing small right pleural effusion.
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