History and Exam : We received a 28-year-old woman, no known chronic illnesses, HIV-seronegative, one month in puerperium having delivered by cesarean section, referred from the obstetrics unit because of persistent chest pain. The pain started when she was 7months pregnant, more on the right side, pleuritic in nature and had progressively increased over time and worsened after delivery. Post-delivery, she also started experiencing evening fevers, lost appetite, and got episodes of difficulty in breathing while lying down and/or sleeping. She had no cough. On examination she was in a fair general condition, not in respiratory distress but worried. Vital signs were: blood pressure 130/80mmHg, pulse 112 beats/minute, Temperature 37.8°C, peripheral saturation of oxygen(SpO2) 96%, respiratory rate 19breaths/minute. Significant findings on chest exam was stony dullness and reduced air entry in the right subscapular and basal lung zones.

Methods : A clinical diagnosis of right pleural effusion was made and patient sent for a chest x-ray (figure1 ) which confirmed an effusion. TB and malignancy were suspected as the cause of the effusion because of the long standing history and constitutional symptoms. Diagnostic thoracentesis was performed and fluid samples taken for ZN Stain, Gene expert, Gram-stain, Culture and cytology. We didn’t do pleural biopsy due to lack of thoracoscopy. ZN Stain reported no acid fast bacilli, Gene expert reported no Mycobacterium tuberculosis detected and Gram-stain revealed no organisms. There was no growth on culture. Fluid cytology revealed scattered lymphocytes and polymorphs on a serous background(figure2 ), thus deducing as chronic lymphocytic pleuritis. There were no malignant cells, no TB on cytological exam. A second pleural fluid sample was taken off for ADA test, having seen the chronic lymphocytic picture of the first sample. ADA test result was 58.6 U/L (Biological Reference Interval 0-40). Based on these findings she was diagnosed with TBP five days after presentation and started on TB chemotherapy composed of rifampicin, isoniazid, ethambutol and pyrazinamide for 2months and Rifampicin and Isoniazid for 4months.

Outcome and follow-up: Treatment commenced on June 1^st 2023 and completed on November 30^th 2023 with 100% adherence as indicated on adherence monitoring tool (figure3 ). By two months of treatment (July 27^th 2023), the effusion had reduced by almost 90%(figure4 ), and completely resolved by 1^stDecember 2023 (figure5 ). She has since been fine, was last reviewed on 9^th February 2024 with normal general and chest findings.