Sweet hydrothorax: a common presentation of a rare condition

Sweet hydrothorax is a known, yet rare, complication of peritoneal dialysis. It can be life-threatening. This case is about a 70-year-old lady who presented with acute respiratory failure due to massive right-sided hydrothorax that developed insidiously over 3 months of starting peritoneal dialysis. Thoracentesis and technetium scan confirmed the diagnosis. Treatment was successful with hemodialysis. Key messages – Peritoneal Dialysis (PD) can be complicated by sweet hydrothorax. – Symptoms onset after initiation of PD and symptoms resolve with its discontinuation suggest the diagnosis. – High gradient glucose level between pleural fluid and plasma is a hallmark feature of sweet hydrothorax. – Patients with life-threatening symptoms can consider hemodialysis or surgical options.