Second Clinical Case of Tuberculous Pleural Effusion

Abstract

This clinical case concerns a young man of 21 with a left pleural effusion associated with a parenchymal consolidation in the left lower lobe and hilar and mediastinal lymph node calcifications. A fibre optic bronchoscopy was performed for complete microbiological examination including AFB smear, TB-NAAT and culture examination; all investigations were negative. A left posterior thoracentesis was performed; complete microbiological examination of the pleural fluid was performed, with the absence of bacteria; the cytological examination of the pleural fluid documented lymphocytosis (but the differential cell count was not performed). Antibiotic therapy was started with amoxicillin 1 g + clavulanic acid 200 mg IV every 8 h, and levofloxacin 500 mg/day per os; complete remission of symptoms was achieved, and the patient was discharged on the 10th day.

After 16 months, he presented a painful swelling in the sternal region, without fever. The patient was sent to the surgeon, who under local anaesthesia evacuated and cleaned the abscess formation; the histological examination showed a caseous granulomatous inflammation; the microbiological examination, AFB smear and culture of the aspirated pus were positive for M. tuberculosis, without resistance to anti-tuberculous drugs.