Cholesterol Pleural Effusion caused by Tuberculosis: Case Report and Systematic Review of the Literature

Background: Pleural effusion (PE) is a common disease in clinical practice. Cholesterol PE or pseudochylothorax is a special type of exudative PE. For the lack of deep understanding of cholesterol PE, it is easy to misdiagnose in clinical practice. Case presentation: A 65-year-old male patient was diagnosed with Secondary tuberculosis (both lungs, smear positive, initial treatment), Tuberculous pleurisy, Cholesterol Pleural Effusion. 800 ml yellow pleural effusion (“Motor-oil” appearance) was drained from the patient’s pleural space after admission. A large number of crystals were observed from the patients’ pleural effusion. The level of Cholesterol (CHOL) of the patients’ PE was 11.41mmol/L. According to the weight of the patients, Isoniazid (0.3g/d), Rifampicin (0.45g/d), Pyrazinamide (2g/d), and Ethambutol (0.75g/d) were used to treat tuberculosis. And small doses of glucocorticoids (start with 32 mg of methylprednisolone, then decrease by 8 mg every week, and stop after 4 weeks) were used to inhibit pleural effusion. The pleural effusion was obviously absorbed, and the sputum smear was negative of the patient subsequent to his visit On May 22, 2021 Conclusions: Cholesterol PE is a rare condition that mainly results from tuberculosis or rheumatoid diseases. “Motor-oil” appearance, numerous rhomboid-shaped cholesterol crystals, and pleural fluid cholesterol (PFCHOL) higher than 200 mg/dL are the key characteristics of Cholesterol PE. The treatment of Cholesterol PE is dependent upon the underlying disease. Glucocorticoid seemed to be an effective adjunctive therapy for Cholesterol PE.