11th January 2024

A 24-year-old medical student returns from a 3-month elective in India with progressive shortness of breath.

A 24-year-old medical student returns from a 3-month elective in India with progressive shortness of breath. She reports working in rural and urban parts of India during the period and lived with a local family for half of the elective period. Since returning, she has struggled with progressive shortness of breath on exertion with associated temperatures and can now only walk 100 yards. A chest x-ray was completed, which showed a unilateral right-sided pleural effusion. A diagnostic aspiration is completed. 

Investigations: 

Pleural pH: 7.34

Pleural protein level: 56g/L 

Pleural LDH level: 345 units/L. 

Pleural M, C + S: Negative gram stain, culture ongoing. Lymphocytosis 90%. 

Given the likely diagnosis, what is the most appropriate treatment? 

Select the SINGLE most appropriate option from the list below. Select ONE option only.