12 years old male presented to the casuality complaining of: fever,dry cough,S.O.B and swelling of the left face,neck and upper limb for 7 days PTA. O/E: finger clubbing grade 2, hepato splenomegaly, visible pulsations in the pericordium and supra sternal notch,tachycardia,tachypnea,stony dullness over the lower zones of the chest. Investigations done as follow.. BFFM +ve Hb% 9 gm TWBC 15.000 mainly lymphocytes ESR 115 RFT was normal x-ray shows bilateral pleural effusion (moderate amount) CT scan of the chest shows cystic bronchiectasis and basal bulle.. pleural fluid tap was hemorrhagic and it's analysis show: protiens : 4.5 g/dl sugar : 56 g/dl cells : lymphocytosis mantoux test was negative.. sputum for acid fast bacilli was negative.. echocardiography done and was normal. Rx : patient received I.V ceftrixone and ampiclox for 2 weeks and now he is on Ampiclox and cefixime capsules.. please.. help us to reach a spot diagnosis and proper management.. Thank you for being patient with us..