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SESSION TITLE: Late-breaking Abstract Posters SESSION TYPE: Original Investigation Posters PRESENTED ON: October 18-21, 2020 PURPOSE: COVID-19 is an ongoing pandemic of international concern caused by a newly discovered Novel corona virus The virus was first identified in Wuhan, China and has spread throughout the world causing a global health crisis Wide range of clinical presentations of COVID 19 has been demonstrated in the literature We present a case of isolated pleural effusion in a patient infected with SARS-CoV-2 METHODS: A 52-year-old male patient, presented with three weeks history of right sided chest pain, dyspnea, and fever On examination, patient was comfortable with normal vital signs during admission and chest examination was remarkable for decreased breath sound on the right side Investigations showed high C-reactive protein, raised ferritin, hyponatremia and increased liver enzymes Chest x -ray and CT scan demonstrated moderate right sided pleural effusion and pleural thickening with normal lung parenchyma Diagnostic pleural analysis was consistent with an exudative effusion with pleural fluid PH of 7 5, glucose of 6 8 mmol/L and very high LDH of 1185U/L The pleural fluid differential white cell count had 45% lymphocytes, 41% neutrophils, 9% eosinophils with cytology negative for malignant cells Pleural fluid stains and culture were negative for bacteria and tuberculosis RESULTS: In view of significant community spread of SARS-COV2, nasopharyngeal swab for COVID 19 PCR was performed, and came back positive Nonetheless patient underwent medical thoracoscopy and pleural biopsy to rule out common causes based on epidemiology mainly tuberculosis and malignancy Parietal pleura was inflamed with few thin adhesions Histopathological examination revealed acute inflammation and reactive spindle cell proliferation with no evidence of granulomas or malignancy Patient received hydroxychloroquine and azithromycin for 5 days based on local guidelines for COVID 19 At 6 weeks follow up, patient is clinically well with minimal pleural thickening on chest X-ray CONCLUSIONS: COVID 19 exhibits a diverse range of clinical presentations and our knowledge about this disease is constantly evolving The hallmark findings of COVID 19 include bilateral patchy ground glass opacities with a predominantly peripheral distribution The most common pleural change in COVID 19 patients is pleural thickening while pleural effusion is extremely uncommon Our patient had an exudative effusion with high LDH and normal pleural fluid PH and glucose Elevated pleural fluid LDH levels (greater than 1000 IU/L) suggest empyema, malignant effusion, rheumatoid effusion, or pleural paragonimiasis As all relevant pleural fluid microbiology was negative and the patient improved on the COVID 19 guideline based treatment, we attribute the pleural effusion to be secondary to SARS Cov-2 and highlight that the effusion in COVID 19 has a high pleural LDH Our assumptions need further confirmation with more studies CLINICAL IMPLICATIONS: – DISCLOSURES: No relevant relationships by Mona Allangawi, source=Web Response No relevant relationships by Anam Elarabi, source=Web Response No relevant relationships by Mansoor Hameed, source=Web Response No relevant relationships by Irfan Ul Haq, source=Web Response No relevant relationships by Mousa Shaher Hussein, source=Web Response No relevant relationships by Merlin Thomas, source=Web Response
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