The patient was started on prednisone given the pleural involvement and recurrence of the pleural effusion. Tunneled pleural catheter was drained daily and remained in the pleural cavity for 20 days until auto-pleurodesis was achieved as documented by pleural ultrasound.
The diagnostic approach to pleural effusion of undetermined etiology should include reevaluation of the patient’s history, occupational exposure, risk factors for tuberculosis, and comorbid diseases. When clinical examination and pleural fluid analysis do not lead to diagnosis, additional investigation through imaging and medical thoracoscopy with pleural biopsy are indicated.14
It is important to highlight that the presence of a pleural effusion in a patient with sarcoidosis cannot be attributed to pleural sarcoidosis involvement until there is histopathologic evidence of noncaseating granulomas in the pleura and malignancy or infectious causes have been excluded. The demonstration of noncaseating granulomas on a pleural biopsy and exclusion of alternate granulomatous diseases, confirms the diagnosis of sarcoid pleural effusion.15,16
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