Abstract
BackgroundThe pathogenesis of primary tuberculous pleurisy is a delayed-type hypersensitivity immunogenic reaction to a few mycobacterial antigens entering the pleural space rather than direct tissue destruction by mycobacterial proliferation. Although it has been shown that pulmonary tuberculosis induces 18-fluorodeoxyglucose (FDG) uptake in active lesions, little is known about the application of FDG positron emission/computed tomography (FDG PET/CT) to the management of primary tuberculous pleurisy.Case presentationWe report a case of asymptomatic primary tuberculous pleurisy presenting with diffuse nodular pleural thickening without distinct pleural effusion and parenchymal lung lesions mimicking malignant mesothelioma. An initial FDG PET/CT scan demonstrated multiple lesions of intense FDG uptake in the right pleura and thoracoscopic biopsy of pleural tissue revealed caseous granulomatous inflammation. The patient received antituberculous therapy for 6 months, with clearly decreased positive signals on a repeated FDG PET/CT scan.ConclusionFDG PET/CT imaging may be useful for evaluating disease activity in tuberculous pleurisy patients with an unknown time of onset.
Highlights
The pathogenesis of primary tuberculous pleurisy is a delayed-type hypersensitivity immunogenic reaction to a few mycobacterial antigens entering the pleural space rather than direct tissue destruction by mycobacterial proliferation
We report here a case of asymptomatic primary tuberculous pleurisy with intense FDG uptake mimicking malignant mesothelioma
Duysinx et al suggested that FDG Positron emission tomography (PET)/Computed tomography (CT) is an effective tool for differentiating between benign and malignant pleural diseases
Summary
18-fluorodeoxyglucose positron emission/computed tomography (FDG PET/CT) is a noninvasive imaging technique that visualizes glucose metabolism and has been regarded as useful for differentiating between benign and malignant diseases [1,2]. An initial FDG PET/CT scan demonstrated multiple lesions of intense FDG uptake in the right pleura (maximal standard uptake value (SUVmax) = 10.9) (Figure 2A and Figure 3A). He had no history of pulmonary or autoimmune disease or occupational exposure to asbestos, silica, or other fibrogenic substances. No positive culture was obtained, other clinical data suggested that a diagnosis of tuberculous pleurisy was highly likely in this case and the patient received antituberculous therapy for 6 months (2HREZ/4HRE) without any side effects. A repeated FDG PET/CT scan revealed clearly decreased positive signals (SUVmax = 5.7) with marked improvements in pleural thickening (Figure 2B and Figure 3B). Six months after the completion of chemotherapy, a chest radiograph showed further improvements in pleural based opacities relative to that taken just after chemotherapy (Figure 1B and C)
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