[Primary tuberculous pleurisy. The course of 3 untreated cases]

Three patients with pleurisy, all exposed to tuberculosis (TB) in their environment, are presented. The etiology of the pleurisy was not initially uncovered and as the pleurisy resolved spontaneously, the patients were discharged from follow up after four to 21 months. Within two to 12 months hereafter, the patients showed up with post-primary tuberculosis: (case I) with miliary tuberculosis incl. meningeal tuberculosis, case II with apical lung tuberculosis and case III with extrapulmonary tuberculosis of the bones. After six months of combined anti-tuberculosis chemotherapy all patients recovered completely. Primary tuberculous pleurisy is known usually to be self-limited but the reactivation rate is high; up to 65% of the adult patients develop post-primary tuberculosis within five years, if not treated. Therefore, prompt diagnosis and treatment are important. Pleurisy in patients with TB in their environment should be intensively examined with cultures of all potentially diagnostic specimens; cultures from pleura fluid alone have a low diagnostic yield and diagnostic blind closed or thoracoscopic open biopsy from the pleura for cultures and histologic examination should be performed whenever possible. If the etiology is not found, the patient should be followed for at least five years.