Liu XP, Mao CX, Wang GS, Zhang MZ. Metagenomic next-generation sequencing for pleural effusions induced by viral pleurisy: A case report. World J Clin Cases 2023; 11(4): 844-851 [PMID: 36818630 DOI: 10.12998/wjcc.v11.i4.844]
Corresponding Author of This Article
Ming-Zhou Zhang, PhD, Professor, Institute of Respiratory Disease, Xinqiao Hospital, Third Military Medical University, No. 183 Xinqiaozheng Street, Chongqing 400037, China. mingzhou06@tmmu.edu.cn
Research Domain of This Article
Respiratory System
Article-Type of This Article
Case Report
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Xue-Ping Liu, Guan-Song Wang, Ming-Zhou Zhang, Institute of Respiratory Disease, Xinqiao Hospital, Third Military Medical University, Chongqing 400037, China
Chen-Xue Mao, Department of Laboratory Diagnosis, Chongqing KingMed Center for Clinical Laboratory Co., Ltd, Chongqing 400050, China
Author contributions: Liu XP and Wang GS collected the clinical information; the manuscript was written by Liu XP and Mao CX, and revised by Zhang MZ.
Informed consent statement: Informed written consent was obtained from the patients for the publication of this report and any accompanying images.
Conflict-of-interest statement: Author Chen-Xue Mao is employed by ChongQing KingMed Center for Clinical Laboratory Co., Ltd. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Ming-Zhou Zhang, PhD, Professor, Institute of Respiratory Disease, Xinqiao Hospital, Third Military Medical University, No. 183 Xinqiaozheng Street, Chongqing 400037, China. mingzhou06@tmmu.edu.cn
Received: August 24, 2022 Peer-review started: August 24, 2022 First decision: December 13, 2022 Revised: December 31, 2022 Accepted: January 16, 2023 Article in press: January 16, 2023 Published online: February 6, 2023
Abstract
BACKGROUND
Viral pleurisy is a viral infected disease with exudative pleural effusions. It is one of the causes for pleural effusions. Because of the difficult etiology diagnosis, clinically pleural effusions tend to be misdiagnosed as tuberculous pleurisy or idiopathic pleural effusion. Here, we report a case of pleural effusion secondary to viral pleurisy which is driven by infection with epstein-barr virus. Viral infection was identified by metagenomic next-generation sequencing (mNGS).
CASE SUMMARY
A 40-year-old male with a history of dermatomyositis, rheumatoid arthritis, and secondary interstitial pneumonia was administered with long-term oral prednisone. He presented with fever and chest pain after exposure to cold, accompanied by generalized sore and weakness, night sweat, occasional cough, and few sputums. The computed tomography scan showed bilateral pleural effusions and atelectasis of the partial right lower lobe was revealed. The pleural fluids were found to be yellow and slightly turbid after pleural catheterization. Thoracoscopy showed fibrous adhesion and auto-pleurodesis. Combining the results in pleural fluid analysis and mNGS, the patient was diagnosed as viral pleuritis. After receiving Aciclovir, the symptoms and signs of the patient were relieved.
CONCLUSION
Viral infection should be considered in cases of idiopathic pleural effusion unexplained by routine examination. mNGS is helpful for diagnosis.
Core Tip: Pleural effusion is a common clinical symptom, and infectious pleurisy is one of the reasons. Its pathogen is difficult to be found by microbiological examination, and the diagnosis of viral pleural effusion is particularly difficult. Epstein-barr virus is latent infection in most adults, and it is easy to be reactivated in people with immune deficiency, which may cause infection in all parts of the body. When idiopathic pleural effusion is not clearly diagnosed through routine examination, the possibility of viral infection should be considered, and early improvement of metagenomic next-generation sequencing examination is helpful for the diagnosis.
