Tuberculous pleural effusion – relapse or re-infection? Follow up of a case report and review of the literature

Abstract

IntroductionThis is a case report of pleural effusion with acute drug reactions to anti-tubercular drugs. Case presentationA 45year old female patient had the typical signs and symptoms of tuberculosis with continuous coughing, breathlessness and protruded abdomen. The USG abdomen showed fluid in the left pleural space. Thoracocentesis was carried out thrice at an interval of 15days and about 5.15L were aspirated. The symptoms of dyspnea and cough were relieved. There was acute drug reaction after starting the ATT. The blood pressure was very high requiring hospital admission. The patient was monitored during the entire course of treatment. No fluid in the bilateral pleural spaces was observed in USG after 6months of treatment.This patient had spinal tuberculosis 8years ago and had recovered following ATT. Therefore, it is difficult to say whether pleural effusion was due to relapse of a previous infection or a re-infection. It is also not known whether TB patients remain susceptible to yet another infection in some other extra-pulmonary site. ConclusionAbdominal TB should be suspected in patients with fever, abdominal pain and ascites. Sputum induction (in addition to pleural fluid) for acid-fast bacilli and culture is a recommended procedure in all patients with TB pleurisy.This condition carries good prognosis, if promptly diagnosed and treated. A reasonable management strategy for pleural TB would be to initiate a four-drug regimen and perform a therapeutic thoracocentesis in patients with large, symptomatic effusions. Prolonged follow-up is essential in cases of pleural effusion, as in the presented case.