AIM: Recurrent pleural effusion represents a clinical challenge, particularly in elderly and frail patients. While talc pleurodesis is traditionally considered the treatment of choice, the use of tunneled indwelling pleural catheters (IPCs) offers a less invasive alternative with fewer associated risks. This case report describes the management of recurrent malignant pleural effusion in a centenarian using a tunneled indwelling catheter. CASE PRESENTATION: A 100-year-old woman, not eligible for invasive treatments due to her advanced age and frailty, was initially managed with talc pleurodesis using the “slurry” technique. The treatment was unsuccessful, with recurrence of the effusion observed after 20 days. The patient was subsequently treated with the placement of a 15F tunneled catheter (UNICO™ In-Vita CH 15, REDAX, Poggio Rusco, Italy) under local anesthesia for long-term effusion control. Caregivers managed the catheter at home, supported by periodic outpatient follow-ups. RESULTS: Despite the advanced age and complexity of the clinical case, the catheter effectively controlled symptoms without complications such as infections or dislocations. The patient reported significant improvement in dyspnea and quality of life, with a favorable course until her death, which occurred 60 days after catheter placement. The mild inflammation induced by the catheter, as reflected by a 15 mg/L increase in C-reactive protein, likely contributed to progressive pleurodesis, gradually reducing pleural fluid production. This case underscores the role of IPCs as a safe and effective option for managing recurrent pleural effusions in elderly patients, providing symptom relief and improved quality of life with minimal complications. CONCLUSIONS: Tunneled IPCs represent a valuable therapeutic option for elderly patients who are not candidates for more invasive procedures. Adequate caregiver education and regular follow-up are essential to optimizing outcomes and minimizing complications. Further prospective studies are needed to validate these findings and refine treatment strategies for this vulnerable patient population.