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Not your typical hemorrhagic pleural effusion

  • Caleb Hsieh
    Correspondence
    Corresponding author. 3701 Skypark Drive, Suite 200, Torrance, CA 90505
    Affiliations
    UCLA Department of Medicine, Division Pulmonary and Critical Care

    West Los Angeles Veterans Administration Healthcare Center, Pulmonary, Critical Care and Sleep Section; David Geffen School of Medicine at UCLA
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  • Guy W. Soo Hoo
    Affiliations
    UCLA Department of Medicine, Division Pulmonary and Critical Care

    West Los Angeles Veterans Administration Healthcare Center, Pulmonary, Critical Care and Sleep Section; David Geffen School of Medicine at UCLA
    Search for articles by this author
      A 36-year-old Caucasian male with 20 pack-year smoking history, childhood asthma and previous heavy alcohol use presented with progressive dyspnea on exertion and chest tightness for the past month. He lived in the Los Angeles area, but frequently hiked in the Southern California area, including twice in the past year around Bakersfield and after one trip about nine months ago, noted a febrile illness which he felt may have been related to an insect bite. He was seen in our Emergency Department (ED) with a low-grade fever (T = 100.5° F, tachycardia to 142) and sharp right sided head pain. A chest film and laboratories were unremarkable, and his symptoms resolved with a combination of ketorolac, acetaminophen, and intravenous fluids. He was discharged with analgesics and while he had resolution of his fever and chills, he noted some persistent chest discomfort. About four months prior to admission, he was incarcerated for about five days following a verbal altercation, but he specifically denied any physical injury associated with the encounter. He also stopped smoking around that time, and in the ensuing weeks noted slowly progressive chest tightness, malaise, and a non-productive cough. He had been treated by his primary care physician with two outpatient courses of oral antibiotics without relief. He sought medical attention again in the ED and endorsed dyspnea at rest and exertion, anorexia and 10 pounds of weight loss.

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