What question did this study set out to answer?

This report aims to illustrate the challenges in diagnosing tuberculous pleurisy in patients with negative IGRA results.

February 26, 2026Open Access

A Case of Tuberculous Pleurisy Highlighting the Need to Consider Primary Tuberculosis in Interferon-Gamma Release Assay-Negative Patients

Key Points

This report aims to illustrate the challenges in diagnosing tuberculous pleurisy in patients with negative IGRA results.
Detailed clinical case of a 54-year-old man with negative IGRA results.
Monitoring of pleural fluid ADA levels and eventual culture for Mycobacterium tuberculosis.
Follow-up on the timing of IGRA positivity relative to symptom onset.
Pleural fluid culture confirmed Mycobacterium tuberculosis one month after initial presentation.
IGRA results turned positive approximately two months post-symptom onset.
Findings indicate limitations in using IGRA and ADA as the sole diagnostic methods.

Abstract

We report a case of tuberculous pleurisy in a 54-year-old man who initially presented with negative interferon-gamma release assay (IGRA) results and elevated pleural fluid adenosine deaminase (ADA) levels. Bacteriological confirmation was obtained only when the pleural fluid culture grew Mycobacterium tuberculosis one month later. The IGRA yielded positive results approximately two months after symptom onset. This case highlights the limitations of IGRAs and ADA as definitive diagnostic tools and underscores the need to consider primary tuberculosis in early IGRA negative cases. Clinicians should be aware of the time-dependent nature of immune sensitization when evaluating patients with suspected tuberculous pleurisy.

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Cite This Study

Takeda et al. (Thu,) studied this question.

synapsesocial.com/papers/699fe28895ddcd3a253e6409 https://doi.org/https://doi.org/10.2169/internalmedicine.6693-25

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