Bilateral parapneumonic effusions are a marker of severe pneumonia.
The patient was managed conservatively with IV benzylpenicillin and oral doxycycline as per local guidelines for moderate community acquired pneumonia. Following clinical deterioration, ultrasound guided thoracocentesis of right pleural cavity was performed with marked improvement in symptoms.
Cytology was negative for malignancy. MC&S was negative for bacterial growth. The pleural fluid was grossly clear yellow and microscopically showed macrophages and neutrophils with a leukocyte count of 680 x 106/L.