[Unilateral to bilateral pleurisy: Pleural tuberculosis?]

Area of Science:

• Pediatrics
• Infectious Diseases
• Pulmonology

Background:

• Pleural tuberculosis is a common extrapulmonary form, often causing pleural effusion.
• It is typically seen in children over 10 years old, being rare in infants.

Observation:

• A 19-month-old girl presented with prolonged fever and unilateral pleural effusion.
• Initial diagnostic tests, including tuberculin skin test and PCR GeneXpert, were negative.
• Despite initial antibiotic treatment and apparent improvement, bilateral pleural effusion recurred.

Findings:

• Pleural fluid analysis showed lymphocytic exudate.
• Despite negative initial molecular tests, pleural fluid culture confirmed Mycobacterium tuberculosis.
• The child responded well to standard anti-tuberculosis treatment.

Implications:

• This case underscores the importance of considering tuberculosis in young children with unexplained pleural effusion, even with negative initial tests.
• Diagnostic challenges in pediatric pleural tuberculosis necessitate a high index of suspicion and appropriate microbiological investigations.
• Prompt initiation of anti-tuberculosis therapy is vital for managing pediatric pleural tuberculosis and ensuring positive patient outcomes.