Tension hydrothorax in a patient with SARS-CoV-2 pneumonitis and pleural Mycobacterium tuberculosis

• Published in: BMJ case reports 2021-07, Vol.14 (7), p.e243760
• Main Authors: Butt, Mohsin F, Symonds, Maggie, Khurram, Ruhaid
• Format: Article
• Language: English
• Subjects: Blood pressure; Case Report; Case reports; Coronaviruses; COVID-19; Dyspnea; Hepatitis; Hospitals; Infections; Patients; Pleural effusion; Pulmonary embolisms; Severe acute respiratory syndrome coronavirus 2; Tuberculosis
• ISSN: 1757-790X; 1757-790X
• DOI: 10.1136/bcr-2021-243760

Unilateral pleural effusions are uncommonly reported in patients with SARS-CoV-2 pneumonitis. Herein, we report a case of a 42-year-old woman who presented to hospital with worsening dyspnoea on a background of a 2-week history of typical SARS-CoV-2 symptoms. On admission to the emergency department, the patient was severely hypoxic and hypotensive. A chest radiograph demonstrated a large left-sided pleural effusion with associated contralateral mediastinal shift (tension hydrothorax) and typical SARS-CoV-2 changes within the right lung. She was treated with thoracocentesis in which 2 L of serosanguinous, lymphocyte-rich fluid was drained from the left lung pleura. Following incubation, the pleural aspirate sample tested positive for Mycobacterium tuberculosis. This case demonstrates the need to exclude non-SARS-CoV-2-related causes of pleural effusions, particularly when patients present in an atypical manner, that is, with tension hydrothorax. Given the non-specific symptomatology of SARS-CoV-2 pneumonitis, this case illustrates the importance of excluding other causes of respiratory distress.