A case of intrathoracic extramedullary hematopoiesis-associated pleural effusion in a beta-thalassemia intermedia patient and a short literature review

Abstract

Extramedullary hematopoiesis is a phenomenon that occurs in conditions of ineffective bone marrow function. In the context of thalassemias, extramedullary hematopoiesis is more frequently observed in beta-thalassemia intermedia patients, with thoracic paravertebral extramedullary hematopoiesis being relatively common. However, extramedullary hematopoiesis-related pleural effusion is a rare occurrence. Herein, we report a 43-year-old female patient, who presented with worsening dyspnea and a massive pleural effusion. Her medical history includes beta-thalassemia intermedia with known paravertebral extramedullary hematopoiesis sites and a laparoscopic cholecystectomy a month ago. The absence of pleural fluid from recent prior imaging pointed toward the rapid accumulation of fluid. After a thorough diagnostic workup, we attributed the effusion to thoracic paravertebral extramedullary hematopoiesis. The patient was effectively treated with drainage of the effusion after thoracentesis and antibiotics. On follow-up, she had a stable radiographic image without pleural fluid recurrence. Extramedullary hematopoiesis-associated pleural effusion should be in the differential diagnosis of pleural effusion, in cases of compatible medical history.