An Unusual Cause of Pleuritic Pain

A 75-year-old man with asthma, alcohol misuse, and previous smoking presented with pleuritic chest pain. He was alert, afebrile, hemodynamically stable, and nonhypoxemic. Computed tomography (CT) revealed a moderate right pleural effusion, right middle and lower lobe consolidation, and right lower lobe bronchus obstruction (Fig 1). Thoracentesis yielded turbid, orange exudative fluid (pH 7.4, 483 cells/μL, 88.7% polymorphonuclear cells, lactate dehydrogenase 485 U/L, glucose 76 mg/dL). Follow-up CT showed reduced pleural effusion.