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Case Reports
. 2021 Feb 1;60(3):449-452.
doi: 10.2169/internalmedicine.4668-20. Epub 2020 Sep 19.

Transudative Pleural Effusion Associated with Extramedullary Hematopoiesis

Keito Enokida  1 , Katsuyoshi Tomomatsu  1 , Naoki Okada  1 , Tomoe Takeuchi  1 , Takahisa Takihara  1 , Jun Amaki  2 , Naoki Hayama  1 , Tsuyoshi Oguma  1 , Takuya Aoki  1 , Koichiro Asano  1
Affiliations
Case Reports

Transudative Pleural Effusion Associated with Extramedullary Hematopoiesis

Keito Enokida et al. Intern Med. .

Abstract

The authors report a case of transudative pleural effusion associated with extramedullary hematopoiesis due to the presence of a myeloproliferative neoplasm, which was unclassified. A 71-year-old man presented with right pleural effusion during an exacerbation of thrombocytosis. The pleural effusion was transudative, although there was no history of cardiac failure or hypoalbuminemia, and treatment with diuretics failed. Extramedullary hematopoiesis was diagnosed in bilateral paravertebral soft tissue and the liver on 111In bone marrow scintigraphy. The administration of hydroxyurea simultaneously reduced peripheral blood platelet count and pleural effusion within 2 weeks. The possible cause of transudative pleural effusion in association with extramedullary hematopoiesis is discussed.

Keywords: bone marrow scintigraphy; hydroxyurea; myeloproliferative disorders; transudate.

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Conflict of interest statement

The authors state that they have no Conflict of Interest (COI).

Figures

Figure 1.
Figure 1.
Peripheral blood cell counts during the treatment. The white blood cell count (WBC; ×109/L, solid line), hematocrit (Ht; %, dotted line), and platelet count (Plt; ×109/L, two-dot chain line) in the peripheral blood during the treatment are presented. Hydroxyurea, 500 mg once daily, was started on day 20 after the admission (X), with a rapid decrease in white blood cell count, hematocrit, and platelet count. Self-discontinuation of medication in an outpatient setting was accompanied by a temporary increase in peripheral blood cells. PIPC/TAZ: piperacillin/tazobactam, VCM: vancomycin, CEX: cefalexin
Figure 2.
Figure 2.
Radiographic findings before and after treatment with hydroxyurea. Chest radiograph and thoracic computed tomography (CT) scan before hydroxyurea treatment (A, C), and 2 weeks (B, D) or 3 months (E, F) after the administration of hydroxyurea. CT revealing uniformly enhanced soft-tissue density in the paravertebral region (D, F).
Figure 3.
Figure 3.
111In bone marrow scintigraphy. 111In accumulation in the bone marrow was observed in the paravertebral soft tissue at the levels of Th5-Th10 (A, B; arrowhead) and in the liver (A, C).
See this image and copyright information in PMC

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