Pleural Tuberculosis: A Febrile Presentation Without Respiratory Symptoms

Area of Science:

• Pulmonology
• Infectious Diseases
• Public Health

Background:

• Tuberculosis (TB) remains a significant global public health challenge, with pleural TB representing a substantial proportion of cases worldwide.
• While TB prevalence is considerably lower in the United States compared to global rates, awareness and diagnostic proficiency are crucial.
• Conventional diagnostic methods for pleural TB can be time-consuming and may lack consistent accuracy.

Observation:

• A case is presented of a patient experiencing fevers without a cough, who was later diagnosed with a large pleural effusion.
• The patient was determined to have pleural tuberculosis (TB) despite the absence of pulmonary parenchymal involvement.
• This clinical presentation underscores the importance of considering TB in patients with unexplained pleural effusions.

Findings:

• The diagnosis of pleural TB was confirmed in a patient presenting with atypical symptoms (fever, no cough) and significant pleural effusion.
• Diagnostic challenges are highlighted due to the non-specific presentation and limitations of conventional testing.
• The patient demonstrated a positive clinical response to empiric treatment, indicating the efficacy of prompt management.

Implications:

• This case emphasizes the need for heightened clinical suspicion for pleural TB in the US, even in low-prevalence settings.
• It highlights the potential for TB to manifest solely as pleural effusion, without typical pulmonary symptoms.
• Effective empiric treatment can lead to significant improvement, underscoring the importance of timely diagnosis and management of pleural TB.