Title : Unveiling the clinical spectrum of pleural tuberculosis: A case series
Abstract:
Background: Tuberculosis (TB) is a leading cause of adult deaths globally, with the Philippines ranking third, where almost one million people suffer from ac ve TB. Sadly, it claims almost 70 lives daily. EPTB is a rare form of TB, accoun ng for 14-15% of cases in 2005-2007, rising to 20% in 2010-2013. Pleural TB is the second most common type in adults and the primary cause of pleural effusion. This report showcases three unique cases of pleural TB and discusses available treatments.
Case Description
Case 1: 22-year-old male with pulmonary tuberculosis and non-compliance with medica on, leading to pleural effusion and septa ons, requiring video-assisted thoracoscopy (VATS). Posi ve for M. tuberculosis with intermediate RIF resistance. Treatment with tuberculosis medica on led to improvement.
Case 2: 38-year-old male with a secondary spontaneous pneumothorax progressing to pneumohydrothorax. Diagnosis of empyema and loculated lung abscess with posi ve results for MRSA and MTB GeneXpert. Treated with Vancomycin, Imipenem, and an-tuberculosis medica ons, and showed improvement.
Case 3: 67-year-old male with progressive dyspnea on exer on, cough, weight loss, loss of appe te, and pleuri c chest pain. Diagnosis of pneumohydrothorax, extensive inters al-nodular infiltrates in the right lung, mul ple sub-cenmeter medias nal lymph nodes, and a ly c bone lesion at T9. VATS drained purulent material and a thick pleural peel, and pleural fluid analysis showed a milky appearance with high lymphocytes, low cholesterol, and high triglycerides. Posi ve for Mycobacterium tuberculosis. Histopathology showed casea ng chronic granulomatous inflamma on. Started on an-tuberculosis medica ons.
Discussion: TB caused by Mycobacterium tuberculosis, is a major infec ous disease with high mortality rates worldwide. TB can affect various organ systems, with the lymph nodes, pleura, genitourinary tract, bones and joints, meninges, peritoneum, and pericardium being the most commonly affected sites. Tuberculous pleural effusion (TPE) is a common complica on of TB and presents with symptoms such as fever, cough, chest pain, night sweats, weakness, shortness of breath, and weight loss. If le untreated, TPE may lead to the development of tuberculous empyema (TE) or pseudochylothorax (PCT). TE is a chronic infec on of the pleural space characterized by thick pus and calcifica on of the visceral pleura, while PCT is an uncommon type of pleural effusion characterized by high cholesterol content and milky pleural fluid. PCT can be caused by TB, rheumatoid arthri s, paragonimiasis, echinococcosis, neoplasia, or trauma. CONCLUSION: Pleural TB can present in various forms, such as septated pleural effusion, recurrent pneumothorax with TPE, and pseudochylothorax. Symptoms like chronic cough, dyspnea, weight loss, and loss of appe te should raise suspicion of TB. Careful evalua on of medical history is necessary for accurate diagnosis and effec ve treatment. Addi onally, it's important to consider EPTB when managing TB cases.
