A 52-year-old male patient, presented with a three weeks history of right-sided chest pain, dyspnea, and fever. The patient denied having night sweats, weight loss, and anorexia. He had no contact with sick patients and no previous history of any respiratory illness. He was non-smoker, with no family history of malignancies. Physical examination revealed decreased breath sounds on the right side. Laboratory results showed a high C-reactive protein, ferritin, and liver enzymes along with hyponatremia (Table 1). Chest X-ray and CT scan demonstrated a moderate right-sided pleural effusion, pleural thickening, and normal lung parenchyma (Fig. 1, Fig. 2). A diagnostic pleural tap was performed. The pleural fluid analysis was consistent with an exudative effusion with a pleural fluid PH of 7.5, the glucose of 6.8 mmol/L, and a high LDH of 1185U/L. The pleural fluid differential white cell count showed 45% lymphocytes, 41% neutrophils, and 9% eosinophils. No organism was detected in the pleural fluid including TB on culture and PCR, and the cytology was negative for malignant cells (Table 2). Given the significant community spread of SARS-COV2, a COVID-19 PCR was performed which was positive. Nonetheless, the patient underwent medical thoracoscopy and pleural biopsy to rule out other pathologies as the cause for the effusion. At thoracoscopy visually the parietal pleura was found to be mildly inflamed with a few pleural adhesions (Fig. 3). Histopathological examination showed acute fibrinous exudate consisting of layers of fibrin mixed with abundant neutrophils (Fig. 4). Also seen were areas of dense fibrosis characterized by fascicles of spindle cells mixed with fewer numbers of lymphocytes, plasma cells as well as eosinophils associated with deposits of dense collagen (Fig. 5) with no evidence of granulomas or malignancy. Culture samples of the pleural biopsy were negative for TB. He clinically improved on hydroxychloroquine and antibiotics.