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pleural effusion lymphocytosis
Conditions with WBC >= 80% lymphocytes in pleural fluid.
Etiology:
- Mycobacterium tuberculosis (tuberculous pleural effusion)
- chylothorax
- lymphoma
- yellow nail syndrome
- rheumatoid arthritis
- CBAG
- sarcoidosis
- acute lung transplant rejection
- uremic pleurisy
Laboratory:
- adenosine deaminase in pleural fluid highly specific for tuberculous pleural effusion
- pleural fluid pH < 7.4 & low pleural fluid glucose suggests pleural tuberculosis
Management:
- positive tuberculin skin test:
- treat for pulmonary tuberculosis [1]
- negative tuberculin skin test:
- pleural biopsy with mycobacterial culture [2]
General
causes of pleural effusion
References
- Medical Knowledge Self Assessment Program (MKSAP) 11, 14, 15,
16, 17, 18, 19. American College of Physicians, Philadelphia 1998, 2006,
2009, 2012, 2015, 2018, 2021.
- Medical Knowledge Self Assessment Program (MKSAP) 19
Board Basics. An Enhancement to MKSAP19.
American College of Physicians, Philadelphia 2022
- NEJM Knowledge+ Question of the Week. June 23, 2020
https://knowledgeplus.nejm.org/question-of-week/566/
- Zhou Q et al. Diagnostic accuracy of T-cell interferon-gamma release assays
in tuberculous pleurisy: a meta-analysis.
Respirology 2011 Feb 9; 16:473
PMID: 21299686
- Keng LT et al.
Evaluating pleural ADA, ADA2, IFN-gamma and IGRA for diagnosing
tuberculous pleurisy.
J Infect 2013 Jun 26; 67:294
PMID: 23796864