Key result
Tuberculous pleuritis occurs in 3% to 25% of patients with tuberculosis and can be diagnosed by demonstrating a pleural fluid adenosine deaminase level above 40 IU/L.
Tuberculous pleuritis should be considered in patients with new pleural effusion and can be diagnosed using pleural fluid adenosine deaminase levels >40 IU/L.
May support ADA testing in new effusions; leaves open prospective validation across populations.
When a patient presents with new pleural effusion, the diagnosis of tuberculous (TB) pleuritis should be considered. The patient is at risk for developing pulmonary or extrapulmonary TB if the diagnosis is not made. Between 3% and 25% of patients with TB will have TB pleuritis. The incidence of TB pleuritis is higher in patients who are human immunodeficiency virus (HIV)-positive. Pleural fluid is an exudate that usually has a predominance of lymphocytes. The easiest way to diagnose TB pleuritis in a patient with lymphocytic pleural effusion is to demonstrate a pleural fluid adenosine deaminase level above 40 IU/L. The treatment for TB pleuritis is the same as that for pulmonary TB. Tuberculous empyema is a rare occurrence, and the treatment is difficult.
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Cohen et al. (2015) conducted a review in Tuberculous Pleural Effusion. Tuberculous pleuritis occurs in 3% to 25% of patients with tuberculosis and can be diagnosed by demonstrating a pleural fluid adenosine deaminase level above 40 IU/L.
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