Abstract Introduction Tuberculous pleuritis (TBP) is the second most prevalent type of extrapulmonary tuberculosis, developing in conjunction with either primary tuberculosis or reactivation disease. A conclusive diagnosis necessitates the detection of bacteria in pleural fluid or a pleural biopsy specimen. We present a case of recurrent right-sided pleural effusion attributable to TBP. Case Description An 82-year-old male immigrant from a TB endemic region presented with nonproductive cough, weight loss, and dyspnea. A CT of the chest and abdomen shows pulmonary nodules and moderate bilateral pleural effusions (Figure 1A), omental thickening, and ascites. He denied a smoking history and exposure to chemicals and silica. The patient tested positive for QuantiFERON gold. Right-sided thoracentesis was done, and 800 cc of pleural fluid was drained. Pleural fluid was exudative with a predominance of lymphocytes, and all cultures were negative. The flow cytometry and pleural fluid cytology were negative for the malignancy or lymphoproliferative process. The patient had rapidly reaccumulating right-sided pleural effusion with worsening shortness of breath. Due to recurrent right pleural effusion of unclear etiology, he underwent a right-sided pleuroscopy (Figure 1B) with parietal pleural biopsies and drainage of 1100 cc of exudative fluid. The right parietal pleural biopsies showed granulomatous inflammation (Figure 1C), and a few weeks later acid-fast bacilli (AFB) cultures from the pleural fluid came out to be positive for Mycobacterium tuberculosis (MTB). He initiated four-drug TB therapy with rifampin, isoniazid, pyrazinamide, and ethambutol, with improvements in the pulmonary symptomology. Discussion Histologic examination and AFB cultures of pleural biopsy specimens are the definitive diagnostic approach for tuberculosis pleuritis (TBP). Pleuroscopy can be conducted under MAC, yielding a high diagnostic yield in patients with suspected TBP. The standard six-month treatment of TBP includes RIPE for two months, then isoniazid and rifampin for at least four months. Alternatively, a shorter four-month plan with rifapentine-moxifloxacin can be used. This abstract is funded by: None
Mushtaq et al. (Fri,) studied this question.