Tuberculous pleurisy with false negative adenosine deaminase level- Case report.

Abstract

Background and a_m: Tuberculous pleural effusion is a common disease entity with a spectrum of presentations from a largely benign effusion, The World Health Organization (WHO) recognized 6.3 million new tuberculosis (TB) cases in 2017, 16% corresponding to extrapulmonary forms; pleural tuberculosis is the most common extrapulmonary form in adults. Diagnostic thoracentesis with thorough pleural fluid analysis including biomarkers such as adenosine deaminase (ADA) and gamma interferon achieves high accuracy in the correct clinical context. Definitive diagnosis may require invasive procedures to demonstrate histological evidence of caseating granulomas or microbiological evidence of the organism on smear or culture. Case: We report the case of a 30- year old male patient admitted to the outpatient setting of the hospital with fever, nonproductive cough and pleuritic pain. He had these symptoms for four weeks. His chest x-ray revealed massive pleural effusion on the left hemithorax. The patient comes from an area with a high incidence of tuberculosis, so our diagnostic strategy was combined with a lymphocyte / neutrophil ratio of exudative pleural fluid greater than 0.75 plus closed needle biopsy tissue. Empirical anti-TB treatment was initiated due to the most likely diagnosis of TB. Conclus_on: In this patient who was negative for ADA, the diagnosis was obtained by pleural biopsy. TB should be considered in cases that may be false negative ADA, and pleural biopsy should be performed primarily for pathological diagnosis in all pleural effusions where clinical suspicion for TB persists. In cases where diagnostic delays may occur, empirical treatment should be started in the presence of strong diagnostic suspicion.

Keywords

• Tuberculous pleural effusion
• adenosine deaminase
• empirical anti-TB treatment
• false negative ADA

Kaynakça

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