A case of refactory uremic pleuritis with hemorrhagic pleural effusion in a patient undergoing chronic hemodialysis.

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  • 難治性の血性胸水を呈した尿毒症性胸膜炎と考えられる１透析例

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A patient maintained on chronic hemodialysis for 7 years and 8 months and in a stable state had a large amount of bilateral hemorrhagic pleural effusion. From his clinical symptoms, findings on effusion and its progress, we considered the effusion to be from uremic pleuritis.<br>Case history: A 50-year-old male patient had chronic hemodialysis started in April 1979 because of worsening of chronic glomerulonephritis and he progressed favorably thereafter. However, in his periodical chest X-ray examination in December 1986, bilateral effusion was pointed out but he had no subjective symptoms.<br>Then he developed fever, cough, chest pain and dyspnea which all gradually increased. CRP was 3+, and leucocytosis was noted, but a tuberculin skin test was negative. The first diagnostic thoracocentesis yielded exudative hemorrhagic fluid with a hematocrit reading of 2% and showing high levels of pleural protein at 5.6g/dl, LDH at 847U and glucose at 88mg/dl. Cultures for bacteria including Mycobacterium tuberculosis were negative and cytological examination was evaluated as Class I. Unlike the transudative effusion on overhydration, the pleural effusion did not respond to fluid restriction and aggressive dehydration hemodialysis. The subsequent clinical dilatory course and bilateral thoracocentesis were repeated 15 times, requiring 5 months for improvement. Slight restrictive pulmonary dysfunction remained.

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