A Rare Case of Tuberculosis With Tension Hydrothorax and Rhabdomyolysis in a Young Male From Senegal

Abstract Introduction: Tension hydrothorax is an extremely rare condition. We present a case of tension hydrothorax secondary to pleural tuberculosis in a patient with rhabdomyolysis. To the best of our knowledge, this is the first report of such a clinical presentation. Case: A 24-year-old male, immigrant from Senegal with no prior medical history presented to the ED with a 3-day history of exertional dyspnea and chest pain and a month's history of unintentional weight loss. On arrival Blood pressure 146/93, Pulse 97, Temp 101.2 F Respiratory rate 23, Oxygen Saturation of 96 % in room air was recorded. On examination, he was febrile and tachypneic with tracheal deviation, diminished breath sounds, and dullness to percussion on the left hemithorax. EKG showed Sinus tachycardia. Chest imaging revealed a complete opacification of left lung suggestive of tension hydrothorax with a left-to-right tracheal and mediastinal shift. The workup revealed elevated creatinine kinase (>100,000) and a positive quantiferon test,. Chest Tube was Placed, Approximately 2 L of fluid collected in first 1 hour. Pleural fluid studies showed ADA of 67(positive), LDH 1496, amylase 67, cell count is lymphocytic predominance, protein 50, glucose 32 and cytology was negative for malignant cells. Quantiferron test came out positive. Sputum culture showed No growth, ESR and CRP was elevated, Procalcitonin was 0.62.MRSA and sputum culture negative. Respiratory pathogen profile, Streptococus pneumonae Ag, Legionella pneumophila Urine Ag and Legionella RT PCR was Negative. Pleural fluid analysis was suggestive of exudative in nature with elevated lymphocytes and adenosine deaminase. Patient's condition improved after drainage of the pleural effusion, hydration, and administration of antimicrobials (Cefepime, Ceftriaxone, Azithromycin and Vancomycin). After Final diagnosis patient was started on RIPE therapy ( Isoniazide, Rifampin, Ethambutol, Pyrazinamide) on account of constellations of symptoms, signs, imaging and lab reports. He developed loculated hydropneumothorax and underwent video-assisted thoracoscopy and decortication followed by pleural biopsy suggestive of necrotizing granulomatous inflammation, negative for mycobacteria.Conclusion: This case highlights the rare occurrence of tension hydrothorax secondary to pleural tuberculosis in an immunocompetent young male who developed rhabdomyolysis. This report adds to the medical literature by documenting the first known instance of this unique clinical presentation and the need to be mindful of complications such as loculated hydropneumothorax. The patient's clinical presentation, physical examination, and comprehensive management emphasize the importance of a collaborative, multi-specialty approach in addressing atypical cases.