Tuberculous Pleural Effusion
A 74-year-old man complained of abnormal fatigue, night sweats, and unintended weight loss of 4 kg over the past month. A thoracentesis of his extensive right-sided pleural effusion showed an exudate with a leukocyte count of 2400/µL, 96% of which were mononuclear cells. No pathogen was detected under the microscope or in culture, and examination of the exudate by polymerase chain reaction for Mycobacterium tuberculosis was negative. F-18-FDG PET computed tomography was performed to rule out malignancy. Computed tomography-guided pleural biopsy demonstrated epithelioid cell granulomas with caseation. Tuberculous pleurisy was diagnosed and quadruple therapy for tuberculosis was initiated (isoniazid, rifampicin, pyrazinamide, ethambutol). Shortly after commencement of this treatment, the night sweats and lassitude remitted and the patient gained weight; he felt much better. A 6-month course of treatment was accomplished (2 months of quadruple therapy, then 4 months of isoniazid and rifampicin). The patient recalled having been in contact with tuberculosis patients in his childhood.
Dr. med. Hilte Friederike Geerdes-Fenge, Prof. Dr. med. Emil Christian Reisinger, Zentrum für Innere Medizin, Abteilung für Tropenmedizin und Infektionskrankheiten, Universitätsmedizin Rostock, firstname.lastname@example.org
Dr. med. Juliane Becker, Zentrum für Radiologie, Klinik und Poliklinik für Nuklearmedizin, Universitätsmedizin Rostock
Conflict of interest statement: The authors declare that no conflict of interest exists.
Translated from the original German by David Roseveare
Cite this as: Geerdes-Fenge HF, Becker J, Reisinger EC: Tuberculous pleural effusion. Dtsch Arztebl Int 2018; 115: 839. DOI: 10.3238/arztebl.2018.0839