Pleural involvement in visceral leishmaniasis (VL) is rare and may pose a diagnostic challenge, particularly when it mimics pleural tuberculosis. We report the case of a 39-year-old immunocompetent man who presented with a dry cough and night sweats. Initial workup revealed a small lymphocytic exudative pleural effusion, and pleural biopsy showed granulomatous inflammation with a tuberculoid appearance, leading to empirical antituberculosis treatment. Because of clinical deterioration, persistent pleural effusion, and negative molecular testing for Mycobacterium tuberculosis, further investigations were performed. Thoracoabdominal computed tomography demonstrated a moderately sized loculated right pleural effusion without hepatosplenomegaly. Thoracoscopic pleural biopsy revealed intracellular structures compatible with leishmaniasis, and review of the previous specimen confirmed intracytoplasmic Leishman-Donovan bodies within histiocytes. Serology for Leishmania was strongly positive, and treatment with liposomal amphotericin B led to a favorable clinical evolution, although residual pleural thickening persisted. This case underscores the need to consider VL in the differential diagnosis of persistent lymphocytic exudative pleural effusion, even in immunocompetent patients.
Aharmim et al. (Mon,) studied this question.