Description
A 21-year-old man presented with fever and left-sided chest pain since 4 days. His medical and family history were insignificant, with no history of rheumatological disease.
On examination, he was tachypnoeic (with a respiratory rate of 28/min), tachycardic (with a pulse of 120/min), febrile (with a temperature of 101°F) and had a stony dull note on percussing the left side of the chest, with decreased vesicular breath sounds on auscultation on the same side.
X-ray of the chest revealed bilateral pleural effusion (figure 1) which was aspirated and was found to be exudative in character, and there were 2100 cells, of which 65% were neutrophils; pleural fluid Adenosine Deaminase, Gene Xpert, culture, staining and cytology were negative. Blood culture was negative, and his complete blood count showed leucocytosis. Erythrocyte sedimentation rate was 65 mm/hour, Antinuclear Antibodies(ANA) was 4+ (speckled pattern) and C3, C4 levels were low, anti-U1RNP antibody was positive,...
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