• Xiangxiang Zhou, Jingxuan Wan, and Xin Gan.
• Department of Respiratory and Critical Care Medicine, Jiangxi Provincial Chest Hospital, Nanchang, Jiangxi, China.
• Medicine (Baltimore). 2021 Dec 3; 100 (48): e27982.

RationaleEosinophilic pleural effusion (EPE) is a rare phenomenon in which the etiological diagnosis remains a challenging issue; here, we present a patient who was eventually diagnosed with malignant EPE by parietal pleural biopsy.Patient ConcernsThe patient was a 73-year-old man with pulmonary tuberculosis who was taking isoniazid and rifampin; after 6 months, he had right-sided eosinophilic pleura, and histopathological examination of the parietal pleura revealed malignant cells from the lung.DiagnosisBased on the parietal pleural biopsy, the patient was diagnosed with lung adenocarcinoma with ipsilateral pleural metastasis stage IVA.InterventionsThe patient received a first-line systemic chemotherapy regimen (premetrexed and carboplatin).OutcomesThe patient received 2 cycles of chemotherapy, and based on the response evaluation criteria for solid tumors, he achieved partial response and the effusion disappeared.LessonsThis case presents a patient with tuberculosis who was suffering from an EPE, which was eventually diagnosed as malignant EPE based on histopathological examination through medical thoracoscopy, although multiple Thinprep cytology tests showed no evidence of malignancy, pleural biopsy is necessary to obtain an accurate etiology diagnosis.Copyright © 2021 the Author(s). Published by Wolters Kluwer Health, Inc.

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