Int J Clin Pediatr

International Journal of Clinical Pediatrics, ISSN 1927-1255 print, 1927-1263 online, Open Access

Article copyright, the authors; Journal compilation copyright, Int J Clin Pediatr and Elmer Press Inc

Journal website https://www.theijcp.org

Case Report

Volume 11, Number 1, March 2022, pages 14-19

Recurrent Bilateral Pleural and Pericardial Effusions due to Tuberculosis in a Child With Doose Syndrome: A Case Report

Figures

Figure 1. Comparative illustration of CT scan during admission (a, b, e, f) and first discharge (c, d, g, h). Panels (a) and (b) show a massive pleural effusion of the left lung that compromises all the segments; panels (e) and (f) show a 3D reconstruction to denote the occlusion of the left airway. Panels (c) and (d) show the absence of fluid in the pleural space after 18 days of treatment, while panels (g) and (h) show a full expansion of the lungs. CT: computed tomography.

Figure 2. Pleural effusion image. In panels (a) and (b), CT scan of the mediastinum, with axial and coronal planes, show an increase of fluid in pericardial space. However, after treatment with diuretic therapy, comparative panels (c) and (d), the fluid collected in pleural space has diminished. CT: computed tomography.

Figure 3. Panels (a) and (b) show the X-ray film before the first discharge without evidence of effusion. Panel (c) shows the initial film to second hospital readmission, with recurrent pleural effusion. Panels (d) and (e) correspond to sonography, previous to definitive discharge, with minimal fluid on the left side (L). In contrast, panel f shows lung parenchyma without fluid (R).

Tables

**Table 1.** Serum Analysis of Important Normochromic Normocytic Anemia
	Value		Value
WBC: white blood cell; RBC: red blood cell; Hct: hematocrit; MCV: mean corpuscular volume; MCH: mean corpuscular hemoglobin; MCHC: mean corpuscular hemoglobin concentration.
WBC (× 10³/mm³)	3.82	Urea (mg/dL)	11.9
RBC	334	Creatinine (mg/dL)	0.20
Hb (g/L)	10.5	Protein (mg/dL)	5.4
Hct (%)	32.3	Albumin	2.9
MCV (fL)	96.7	C-reactive protein	12.1
MCH (pg)	31.4	Procalcitonin	0.75
MCHC (g/dL)	32.5	Rheumatoid factor	0
Platel count (× 10³/mm³)	89	Immunoglobulin G	545.60
Neutrophils (%)	24	Immunoglobulin M	55.70
Lymphocytes (%)	55	Immunoglobulin A	7.10
Monocytes (%)	11	Immunoglobulin E	11.73
Eosinophils (%)	7	Complement component 3 (C3)	143.6
Basophils (%)	0	Complement component 3 (C4)	13.7
Lactic dehydrogenase	185	Antinuclear antibody test	0.52
Glucose (mg/dL)	89

**Table 2.** Pleural Fluid Characteristics
A high concentration of protein and leukocyte cells is shown. The negative reaction to Ziehl-Neelsen stain makes the diagnosis of tuberculosis infection hard to reach. LDH: lactate dehydrogenase.
Leukocyte count cells (/mm³)	12,400	pH	8
Lymphocytes	868	Fungal culture	Negative
Neutrophyle	10,664	Glucose (mg/dL)	77.5
LDH (U/L)	155	Ziehl-Neelsen staining	Negative
Count cells (/mm³)	186	Pleural effusion culture	No growth
Protein (g/L)	3.525	Cytology report	Majority of lymphocytes.