Pleural tuberculosis

Background

• Pleural-based infection with Mycobacterium tuberculosis
• Most common extra-pulmonary site of infection

Clinical Manifestations

• Fever, cough, pleuritic chest pain
• Can develop draining empyema (empyema necessitans)

Investigations

• Diagnostic thoracentesis for pleural fluid
  • Typically clear or straw-coloured, but can be turbid or serosanguinous
  • Usually exudative
  • Lymphocyte-predominant leukocytosis 1000 to 6000, though can be neutrophil-predominant in early disease
  • Adenosine deaminase levels can be elevated (threshold around 40 to 60 units/L)
  • May grow TB in culture
• Pleural biopsy may be needed when pleural fluid culture is negative

Management

• As per routine management for tuberculosis
• Does not need routine drainage of pleural effusions, except for comfort
• Can have paradoxical reaction with increased fluid after starting treatment