Eosinophilic pleural effusion and giardiasis: A causal or a casual relationship?
A 32-year-old male, barber by profession presented with complaints of right sided chest pain for 1 month, cough for 20 days and left lower chest pain for 15 days. Patient had breathlessness on exertion for past one month which was gradual in onset. He gave history of loose motions and diffuse pain abdomen off and on for the past three months. He smoked 10-15 bidis per day since last 10 years and took 60-90 ml of alcohol per day for past 2 years. There was no history of any drug abuse. There was no history of any trauma, prolonged bed rest, any invasive procedure involving the chest or any respiratory infection. There was no history of any drug intake or exposure to pets. There was no history of any intake of over the counter medications or any other medication for any ailment. Complete blood count was within normal limits with a Hb of 10.2 gm%, total leucocyte count of 10800/mm3 with a DLC of 61% neutrophils, 30% lymphocytes, 9% eosinophils and an absolute eosinophil count of 1008/mm3. Liver and renal function tests were within normal limits. Electrocardiogram [ECG] did not show any abnormality. X-ray chest [] showed a right sided pleural effusion. Contrast-enhanced computerized tomography (CT) scan [CECT] of chest also revealed bilateral pleural effusion (right > left) without any parenchymal abnormality []. Pleural fluid was aspirated from both the sides.\nThe pleural fluid analysis of both sides showed an exudative pleural effusion with a very high percentage of eosinophils on cytology suggestive of eosinophilic pleural effusion. Right sided PE showed a TLC of 1850/cmm with 96% eosinophils and 4% lymphocytes. Adenosine deaminase [ADA] level was 32 IU/L (N ~ 30 IU/l). Left sided pleural fluid examination showed a TLC of 6400/cmm with lymphocytes 20%, neutrophils 6% and eosinophils 74%. ADA level was 30 IU/l. Pleural fluid pH and glucose was within normal limits. Pleural fluid from both the sides was negative for malignant cells. The results of bacterial, fungal, and acid-fast bacilli stains, and cultures were negative. The only positive, probably an incidental, finding in our case was that the patient's stool for ova was positive for Giardia lamblia. But the pleural fluid examination was negative for giardia and any other parasite. Ultrasonography of the abdomen also revealed no abnormality.\nPatient was put on metronidazole (400 mg BD) for 4 weeks for giardiasis. His abdominal symptoms showed improvement. X-ray chest after one month showed clearing of bilateral PE. After 2 years follow-up the patient is healthy and has no complaints and the pleural effusion has not recurred.