11th January 2024

A 38-year-old gentleman with a background of renal transplant is referred to the ambulatory care unit due to shortness of breath, purulent sputum production and recurrent fevers for the past week.

A 38-year-old gentleman with a background of renal transplant is referred to the ambulatory care unit due to shortness of breath, purulent sputum production and recurrent fevers for the past week. He remains on his usual immunosuppressive regime of prednisolone 10mg OD, tacrolimus 1mg BD and mycophenolate mofetil 1g BD. He has no known allergies. A chest x-ray is completed, which shows a moderate left-sided pleural effusion and a diagnostic aspiration is completed under ultrasound guidance. 

Investigations: 

Serum WCC 36.7 x10*9/L  (4.0-11.0)

Serum CRP 435 mg/L        (<10) 

Pleural fluid pH 6.8 

Pleural fluid protein 41g/L 

Pleural fluid LDH 1654 U/L

Pleural fluid appearance: Frank pus 

Given the likely diagnosis, what is the most appropriate management plan? 

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