Tuberculous Pleurisy Highlighting the Need to Consider Primary Tuberculosis in Interferon-gamma Release Assay-negative Patients.
Saki Takeda, Tatsuya Nagai, Taiki Kawai et al.
✦ AI-curated · Sources linked
Case in brief
A 54-year-old man with suspected tuberculous pleurisy initially had a negative interferon-gamma release assay (IGRA) and elevated pleural fluid adenosine deaminase (ADA). Pleural fluid culture subsequently grew Mycobacterium tuberculosis, providing bacteriological confirmation. The IGRA became positive approximately two months after symptom onset. The case illustrates how early testing may not establish or exclude the diagnosis: culture confirmed tuberculosis while the initial IGRA was negative, and later testing showed a change in IGRA status.
What made this case unusual
The IGRA was initially negative but became positive approximately two months after symptom onset, while pleural fluid culture later confirmed tuberculosis.
Diagnostic / clinical pearl
In suspected tuberculous pleurisy, an early negative IGRA does not exclude tuberculosis; interpret IGRA and pleural fluid ADA in context and consider culture for confirmation.