Case Presentation
A 32-year-old female patient presented with abdominal distension of 3 weeks associated with shortness of breath, excessive fatigue, and loss of appetite. She had no previously known chronic medical illness. She had blood pressure of 100/70mmHg, pulse rate of 72 beats per minute, respiratory rate of 28 breaths per minute, oxygen saturation of 85% at atmospheric air, signs of bilateral pleural effusion and ascites. She had coarse and dry skin over her trunk and extremities [Figure 1].
Complete blood count showed normal white blood cell (WBC) count, moderate anemia (hemoglobin: 9.8 g/dL, MCV: 88 fl) and normal platelet count. Liver enzymes and serum creatinine were within the normal ranges. Thyroid function tests showed high thyroid stimulating hormone (TSH) level with low free T3 and T4 (TSH: 49 mU/L, Free T3: 0.1 pg/mL and Free T4: 0.3 ng/dL). Sputum GeneXpert MTB/RIF test was positive for rifampicin sensitive mycobacterium tuberculosis (TB). Anti-nuclear antibody (ANA) and rheumatoid factor were negative. Pleural fluid analysis revealed WBC count of 1200 cells/µL (neutrophil: 6.7%, Lymphocyte: 93.3%), LDH of 704 IU/L, protein of 5.6 g/dL and glucose of 47 mg/dL. Echocardiography showed pericardial effusion; abdominal ultrasound showed ascites; and chest x- ray showed bilateral pleural effusion [Figure 2].
The patient was diagnosed with polyserositis due to disseminated tuberculosis and primary hypothyroidism and started on anti-tuberculosis medications and oral levothyroxine (100 microgram daily). After a month of initiation of anti-TB and thyroid hormone replacement, patient showed marked improvement of her symptoms and repeated imaging confirmed resolution of the body cavity fluid collections.