A man in his fifties with dry cough and pleural effusion

Pulmonary tuberculosis is a major public health issue worldwide and is frequently overlooked, particularly in our part of the world. More caution with regard to symptoms could facilitate faster diagnosis, better treatment, and decreased morbidity and mortality.

We describe the disease course in a middle-aged man presenting with non-productive cough, right-sided pleural effusion and fatigue. Approximately 3 months passed before he was diagnosed with pulmonary tuberculosis and pleuritis. Because of his mild symptoms and non-specific radiographic findings, he was initially treated with antibiotics covering typical and atypical pneumonia, resulting in some improvement which led to a delay in diagnosis. Thoracic CT examination eventually revealed right upper lobe cavitation, increasing right-sided pleural effusion, right-sided mediastinal and hilar lymphadenopathy, and thickened right-sided pleura and pericardium. Induced sputum samples confirmed growth of M. tuberculosis, the mycobacterium tuberculosis complex was confirmed with PCR analysis, and direct microscopy showed acid-fast bacilli. The patient was successfully treated with standard tuberculostatic drugs: rifampin, isoniazid, pyrazinamide and ethambutol.

Tuberculosis is frequently overlooked, both in hospitals and in primary care. Symptoms may be mild or non-characteristic in the early stage, and a simple chest x-ray is unsuitable to exclude the diagnosis.