Organizing Pleuritis Presenting as Recurrent Lymphocyte Predominant, Exudative Effusion

Our plain-English summary of Organizing Pleuritis Presenting as Recurrent Lymphocyte Predominant, Exudative Effusion, by H. Alaws, S.A. Sujanyal, B. Talwar, et al (The Permanente Journal, 2026).

The study

• Authors: H. Alaws, S.A. Sujanyal, B. Talwar, H. Saunders, A. Balavenkataraman, D. Abia-Trujillo, S. Helgeson
• Journal: The Permanente Journal
• Published: 2026;30(3):195-199
• Type of article: Case report
• Read it: PubMed · Publisher · Free full text

Abstract

Long-standing pleural effusions may rarely progress to pleural fibrosis, and when no identifiable etiology is present, this entity is termed cryptogenic fibrosing pleuritis (also referred to as organizing pleuritis, fibrous pleurisy, or fibrosing pleurisy). This condition is characterized by persistent exudative effusions and progressive pleural thickening, often leading to diagnostic uncertainty and therapeutic challenges. Due to its rarity, only a limited number of cases have been described in the literature, and an evidence-based management strategy has yet to be established. Reported treatments have included glucocorticoids and surgical decortication, with variable success and unclear long-term benefits. The authors have presented the case of an older man with recurrent unilateral lymphocytic exudative pleural effusion, extensive occupational asbestos exposure, and imaging findings concerning for pleural disease, in whom repeated thoracenteses failed to provide durable resolution. Given concern for an underlying malignant process, medical thoracoscopy was pursued, allowing direct pleural visualization and diagnostic biopsy. Histopathology confirmed organizing pleuritis without malignancy. Rapid protocol pleurodesis and placement of a tunneled pleural catheter were performed simultaneously. This case highlighted the diagnostic value and therapeutic potential of thoracoscopy combined with pleural drainage strategies as a less invasive alternative to surgical decortication in carefully selected patients with cryptogenic fibrosing pleuritis.

In plain English

This case report described one 83-year-old man sent from another hospital because fluid kept building up around his right lung (a pleural effusion), despite two earlier drainages of about 1.5 liters each. He reported substantial occupational asbestos exposure while working for the US Navy and a municipal fire department. A CT scan showed an 8 mm calcified pleural plaque. Fluid tests were mostly lymphocytes and showed no cancer cells. Because cancer was a concern, doctors examined the lung lining with a small camera (medical thoracoscopy). They drained 2040 mL of fluid, took biopsies, sealed the space with talc and later iodine, and placed a tunneled drainage catheter. The biopsies showed organizing pleuritis, a benign scarring process, without evidence of malignancy. Fluid had not returned at 3 months, and a CT at 2 years showed no disease progression. The authors found no definitive evidence tying the scarring to asbestos and considered the cause unknown (cryptogenic). The authors concluded the approach was an alternative potential option and said longer follow-up would help exclude a developing cancer.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: case report (single patient)
• Who was studied: One 83-year-old man with liver cirrhosis, hypertension and hyperlipidemia, referred from an outside institution with a recurrent right-sided pleural effusion after 2 prior therapeutic thoracenteses of about 1.5 liters each; the authors are at Mayo Clinic, Jacksonville, FL
• Exposure: Self-reported substantial occupational asbestos exposure from work with the US Navy and a municipal fire department (fiber type not stated); also a 30 pack per year smoking history, as printed
• Main results:
  • Chest CT showed an 8 mm calcified pleural plaque on the anterior pleura, with no parenchymal consolidation or nodules
  • Third thoracentesis: 82% lymphocytes, LDH 85 U/L, protein 4.5 g/dL, glucose 146 mg/dL, cytology negative for malignancy
  • During medical thoracoscopy a total of 2040 mL of pleural fluid was drained and multiple pleural biopsies were taken
  • Biopsies, including keratin immunostaining, showed organizing pleuritis without evidence of malignancy
  • After talc pleurodesis, iodine pleurodesis on day 1 and a tunneled pleural catheter, the patient was discharged on day 3
  • At 3 months the patient reported marked symptom improvement and imaging showed no fluid reaccumulation; a CT at 2 years showed no disease progression
  • The authors found no definitive radiologic or histopathologic evidence attributing the pleural fibrosis to asbestos-related disease, so the cause was considered cryptogenic
• The authors' conclusion: The authors concluded that the case described an alternative potential diagnostic and management option for cryptogenic fibrosing pleuritis, and that patient selection and counseling about possible malignancy are essential
• Limitations the authors state:
  • Longer-term follow-up would be needed to definitively exclude an evolving malignant process
  • Pleural manometry was not performed; absence of trapped lung was inferred from earlier lung reexpansion

Topics

The National Library of Medicine indexes this study under subjects our site covers: Pleural plaques and thickening.

Medical terms in this study, explained in our Lexicon: Standing, Pleural Effusion, Fibrosis, Etiology, Pleurisy, Pleural Thickening, Asbestos Exposure, Medical Thoracoscopy.

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