A Woman in Her 30s With a History of Cervical Cancer Presents With Shortness of Breath and Pleuritic Chest Pain

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A woman in her 30s presented to the ED with a 3-month history of shortness of breath on exertion, dry cough, and pleuritic chest pain. A month ago, the patient was seen at an internal medicine clinic and was found to have a right pleural effusion. A thoracentesis revealed straw-colored fluid, a total nucleated cell count of 1,260 × 106/L, and a differential with neutrophils of 0.15, lymphocytes of 0.55, macrophages/monocytes of 0.19, and eosinophils of 0.10. Fluid cytology and culture were negative. The patient was presumed to have a parapneumonic effusion and treated empirically with antibiotics. However, she continued to have progressive symptoms, prompting her current visit to the ED. The patient was diagnosed with stage IIIB invasive cervical squamous cell carcinoma (SCC) approximately 7 months ago. MRI of the pelvis demonstrated a cervical mass with invasion of the right parametrial fat, but there was no evidence of uterine, vaginal, or lymph node involvement. A CT scan of the chest, abdomen, and pelvis was negative for distant metastases. The patient completed treatment with external beam radiation therapy and cisplatin chemotherapy 6 months ago. Three weeks prior to presentation to the ED, a repeat MRI pelvis showed no evidence of tumor progression and features consistent with posttreatment fibrotic changes.

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