[Clinical analyses of fungal pleurisy: a report of 4 cases].

OBJECTIVE

To explore the clinical features of fungal pleurisy.

METHODS

Four cases of fungal pleurisy diagnosed by medical thoracoscopy at Beijing Chaoyang Hospital from April 2005 to December 2012 were retrospectively studied.

RESULTS

There were 3 males and 1 female with an age range of 43-73 years. The time from initial onset to definite diagnosis was 17 days to 4 months. Among them, two were previously healthy while another two had underlying diseases. The diagnoses were mucor pleuritis (n = 1) and aspergillus (n = 3). There was one case of empyema. One case was diagnosed as non-Hodgkin lymphoma two years ago and had pleural metastasis during hospitalization. And another one suffered concurrently from diabetes mellitus and hypoproteinemia. The primary clinical manifestations included fever (n = 2), cough and sputum (n = 3), breathlessness (n = 4) and weight loss (n = 2). The major chest computed tomography (CT) scan revealed pleural effusion with thickening. All cases had an elevated plasma level of C-reactive protein (CRP). The characteristics of pleural effusion were empyema (n = 1) and exudates (n = 3). Pleural fluid smear and culture tests for bacteria and fungi were negative, so were pleural fluid smear tests for mycobacteria. All cases were confirmed through histopathological examination of pleural biopsies and cured after systemic antifungal therapy and pleural irrigation.

CONCLUSIONS

Fungal pleurisy is infrequent. Early thoracoscopy is vital because of a low positive yield of microbiologic testing of pleural fluid specimens. Systemic antifungal therapy and pleural irrigation improve the prognosis.