Pleural tuberculosis: a key differential diagnosis for pleural thickening, even without obvious risk factors for tuberculosis in a low incidence setting

Abstract

We report the case of a 64-year-old woman, presenting with pleuritic chest pain and weight loss. She had a previous history of breast malignancy and no clear risk factors for tuberculosis (TB). Initial investigations showed a right-sided pleural effusion and pleural thickening suggestive of malignancy, which would have been in keeping with the clinical presentation. Initial pleural biopsy showed features suggestive of possible TB infection, though no growth on cultures. A repeat biopsy was negative on initial microscopy, but was culture positive for Mycobacterium tuberculosis, also identifying isoniazid resistance. This case highlights that TB remains an important differential even in the absence of classical risk factors, and illustrates the diagnostic challenges it poses. It also highlights the value of culture positivity in identification of drug resistance and facilitation of appropriate treatment.

Non-traumatic Diaphragmatic Eventration With Extrapulmonary Tuberculosis Presenting As Pleural Effusion in an Indian Male: The First Report of Its Type

“…As observed in our patient's case, pleural effusions caused by tuberculosis often manifest as moderately sized, predominantly right-sided, and unilateral [ 6 ]. Pleural effusions caused by tuberculosis can be challenging to diagnose, especially when lung parenchymal disease is absent on imaging.…”

“…Tuberculous pleural effusions often resolve spontaneously but may lead to active tuberculosis in up to two-thirds of cases. Therefore, a high index of suspicion is crucial to diagnosing individuals exhibiting characteristics associated with pleural tuberculosis during the window of opportunity for intervention [ 6 ].…”

“…Pleural tuberculosis is seldom reported, even in endemic countries [ 5 ]. Pleural tuberculosis develops in 3-5% of total tuberculosis patients worldwide, although in high-prevalence situations, this number could rise to 30% [ 6 ]. Herein, an exceedingly rare case of left-sided diaphragmatic eventration with extrapulmonary tuberculosis presenting as right-sided pleural effusion in an Indian male is presented.…”

A Rare Case of Pleural Tuberculosis with Tuberculous Pyomyositis

“…Physical therapy (PT) typically manifests unilaterally and may vary in size. [2] In the examination of a substantial population, it was shown that pleural fluid was present exclusively on the left side in 38.1% of cases, exclusively on the right side in 48.4% of cases, and both sides were affected in 13.5% of cases. The most commonly observed symptoms include a non-productive cough, occurring in around 70% of cases, and pleuritic chest pain, also reported in approximately 70% of cases.…”

“…There is a scarcity of published data about the management of pleural tuberculosis accompanied by tuberculous pyomyositis. [2]…”