Tuberculous pleuritis: a not always immediate diagnosis

Key words: Tuberculous pleuritis, Diagnosis, Treatment, Case report

Tuberculous pleuritis usually presents as an acute illness with fever, cough and pleuritic chest pain. The pleural fluid is an exudate that usually shows predominant lymphocytes. Pleural fluid cultures are positive for Mycobacterium tuberculosis in less than 40% and sputum is virtually always negative. In questionable cases the diagnosis can be established by demonstrating granulomas or organisms on tissue specimens obtained via needle biopsy of the pleura or thoracoscopy. The chemotherapy for tuberculous pleuritis is the same as that for pulmonary tuberculosis. The present paper reports a case of a 17- year-old girl with pleural effusion, without parenchymal disease. Tuberculin skin test, bacterial and AFB cultures as well as cytology are negative. The diagnosis of tuberculous pleural effusion is established by demonstrating granuloma in the parietal pleura and by a positive AFB stain.