Black pleural effusion caused by a pancreaticopleural fistula associated with autoimmune pancreatitis: A case report

Abstract

Rationale: Black pleural effusion is a rare medical condition and a diagnostic marker. Pancreaticopleural fistula is one of the causes of black pleural effusion. Thus far, black pleural effusions caused by pancreaticopleural fistulae have mostly been reported in patients with alcohol-induced chronic pancreatitis. In this report, we present a case of black pleural effusion caused by a pancreaticopleural fistula associated with autoimmune pancreatitis. Patient concerns and diagnosis:A 59-year-old female without a history of alcohol drinking presented to our hospital with a chief complaint of dyspnea, as well as chest and back discomfort. She had left pleural effusion, and thoracentesis showed black pleural effusion. Computed tomography revealed the presence of encapsulated fluid from the pancreatic tail to the left pleural cavity, which was diagnosed as a pancreaticopleural fistula. It also showed diffuse pancreatic swelling. Serum testing showed a high IgG4 level (363 mg/dL). These findings led to the diagnosis of autoimmune pancreatitis. Interventions and outcome:The patient underwent endoscopic pancreatic sphincterotomy and pancreatic duct stent placement and received treatment with steroids. After treatment, there was no further accumulation of pleural effusion observed.Conclusion: This is the first report of black pleural effusion due to a pancreaticopleural fistula associated with autoimmune pancreatitis. The characteristic appearance of black pleural effusion may assist diagnosis. We report this case to emphasize that autoimmune pancreatitis can be a cause of black pleural effusion.

Three cases of black pleural effusion

“… Author Age/Sex Diagnosis Management Outcome Watanabe et al [ 10 ] 57/M Pancreaticopleural fistula; Acute on chronic alcoholic pancreatitis Tube thoracostomy Effusion resolved Ye, J. et al [ 11 ] 64/M Pancreaticopleural fistula; Suspected IgG4 Disease Thoracentesis; Endoscopic pancreatic duct stenting Effusion resolved Arumairaj, A.J. et al [ 12 ] 48/M Pancreatic pleural effusion Tube thoracostomy Effusion resolved Miyadera, K. et al [ 13 ] 59/F Pancreaticopleural fistula/Autoimmune pancreatitis Endoscopic pancreatic sphincterotomy and pancreatic duct stent placement/Systemic steroids Effusion resolved Nikiforov et al [ 14 ] 27/M Severe acute pancreatitis Tube thoracostomy Effusion resolved Tanaka, T. et al [ 15 ] 55/M Boerhaave syndrome Thoracentesis; Surgical repair Effusion resolved Jagganath et al [ 16 ] 24/M Pancreaticopleural fistula; Pancreatic pseudocyst Tube thoracostomy, somatostatin analogue; Open cystogastrostomy Effusion resolved Newman et al [ 17 ] 34/M Crack cocaine Thoracentesis Unknown Ng, Z. et al [ 18 ] …”

Black Pleural Effusion Attributable to Post-Endoscopic Retrograde Cholangiopancreatography Pancreatitis

“…The amylase level in the pleural effusion was elevated to 18,825 U/L, and the culture was negative. Black pleural effusion is a rare condition caused by intrathoracic hemorrhaging and hemolysis in-duced by pancreatic juice (1) and is associated with conditions such as metastatic melanoma, lung adenocarcinoma, pleural infections caused by Aspergillus niger and Rhizopus oryzae, esophageal perforation caused by activated charcoal, mediastinal teratoma, and crack cocaine usage (2). Pancreatitis is a common complication of ERCP, while black pleural effusion is less common and can result from rare complications, such as pancreaticopleural fistula, without evident extravasation of contrast agents.…”