An 88-year-old female with eosinophilic pleuritic

• Published in: Acta clinica belgica (English ed. Online) 2015-05, Vol.70 (S3), p.29
• Main Authors: Chung, Chun Yuen Johnny, Stappaerts, Inge, Moorkens, Walter, Nowé, Vicky, Hantson, Inge
• Format: Article
• Language: English
• ISSN: 1784-3286; 2295-3337

An 88-year-old female presented with exertional dyspnea and clinically diminished breath sounds on the left hemithorax. She was transferred from the Neurology department where she was admitted for an encephalopathic syndrome with disturbed attention due to an intoxication with valproate, which she was taking for epilepsy. Two weeks before admission she fell and broke some ribs on the left side. Chest radiography revealed a left sided pleural effusion. A diagnostic and therapeutic thoracocentesis was performed with evacuation of 950 mL of bloody fluid without improvement of the respiratory symptoms. Cytologic examination showed an exudate rich on eosinophilic granulocytes (26%), lymphocytes (10%) and macrophages (48%) in the absence of malignant cells. Peripheral blood analysis showed an elevated eosinophilic fraction (14.3%). Pleural eosinophilia is mostly seen in spontaneous pneumothorax or hemothorax and less likely in infections, malignancies or with drug intake. This patient was suspected to have a valproate-induced eosinophilic pleuritis with peripheral elevation of the eosinophilic fraction. Although a concomitant hemorrhagic rib fracture could have contributed to the presence of pleural eosinophilia, amelioration was seen to be correlated with the withdrawal of valproate as notable on a control examination 6 weeks afterwards with improvement of the respiratory symptoms, absence of pleural effusion on chest radiography and normalization of the peripheral blood eosinophilia. To our knowledge, only a few cases of eosinophilic pleuritis have been described due to valproate intake. Because of its rarity, patient with pleural effusion should be screened for the intake of valproate as a possible cause.