[A case having chyliform pleural effusion caused by former tuberculous pleurisy]

Area of Science:

• Pulmonology
• Infectious Diseases
• Medical Diagnostics

Background:

• A 49-year-old male with a history of pulmonary tuberculosis and tuberculous pleurisy presented with exertional dyspnea.
• Imaging revealed increased pleural effusion and thickened pleura, suggesting a recurrence or complication.

Observation:

• Thoracentesis yielded a yellow, milky fluid with low cell count, high cholesterol (628 mg/dl), and moderate triglycerides (83 mg/dl).
• Acid-fast bacilli smear and PCR-TB tests on pleural fluid were positive, but mycobacterial culture was negative.
• Adenosine deaminase (ADA) levels in the pleural effusion were elevated at 91.7 IU/l.

Findings:

• The patient was diagnosed with chyliform pleural effusion, characterized by lipid-rich fluid.
• Positive TB markers in effusion fluid, coupled with negative culture, indicated the effusion stemmed from a past tuberculosis episode, not active disease.
• Lack of effusion increase post-thoracentesis without anti-TB therapy further supported a non-active TB etiology.

Implications:

• Chyliform pleural effusion can be a sequela of prior tuberculous pleurisy, requiring careful differentiation from chylothorax.
• Diagnostic markers like ADA levels and PCR-TB can aid in identifying the etiology of complex pleural effusions.
• This case highlights the importance of considering chronic inflammatory processes in the pathogenesis of lipid-rich pleural effusions.