Massive Pleural Effusion with Adenosine Deaminase (ADA) Test Positive and COVID-19 Confirmed: A Case Report

A 26-year-old man complained of shortness of breath for 3 days before the hospital admission. The patient had a history of coughing up blood and had consumed alcohol and drugs. Decreased vesicular auscultation and dull percussion in the left lateral pulmo. Laboratory result showed increased neutrophil-lymphocyte ratio C-reactive protein, D-dimer, procalcitonin, ferritin, and decreased albumin level. Pleural fluid analysis indicated the presence of exudate, SARS-CoV-2 PCR positive, and increased ADA level to 43 U/L. Based on the examination results, we suspected that the etiology of the massive pleural effusion was tuberculous pleurisy, particularly due to increased ADA levels. The patient was diagnosed with COVID-19 pneumonia with massive pleural effusion and tuberculous pleurisy. Massive pleural effusion in SARS-CoV-2 infection is rare. Thus, laboratory modalities for massive pleural effusion diagnosis are needed to determine the etiology and effective treatment for the patient. ADA analysis could be considered as an initial examination in patients with pleural effusion during the wait for pleural fluid culture results.