title: An unusual case of a pleural effusion with an abdominal mass.
abstract: A 38-year-old man presented to us with a left sided pleural effusion. Pleural fluid was aspirated and analysis revealed it to be an exudate with predominant lymphocytes and an elevated ADA level. He was discharged on antituberculous treatment. Patient returned with re-accumulation of pleural fluid. Computed tomography done in our institute picked up not only parenchymal disease in the lung which was not evident on chest radiographs but also picked up an abdominal mass in the left renal fossa. Pathological examination of excised mass revealed its tuberculous nature. The repeated recollection of pleural fluid was attributed to a "paradoxical response"; the patient was reassured and his anti-tuberculous treatment continued. Recognition of the fact that evidence of tuberculosis at distant sites may occasionally be needed to substantiate the diagnosis of tuberculous pleural effusion in a difficult and bacteriologically "negative" case prompted us to report this case.
authors.affiliation: Department of Tuberculosis & Respiratory Diseases, Kasturba Medical College & Hospital, N. G Road, Attavara, Mangalore-575 001, Karnataka. dokpreet@yahoo.co.in
authors.forename: Preetam R
authors.initials: PR
authors.lastname: Acharya
authors.forename: Rameshchandra
authors.initials: R
authors.lastname: Sahoo
authors.forename: Poornima
authors.initials: P
authors.lastname: Baliga
mesh_terms: D000328:Adult; D000995:Antitubercular Agents / Q000627:therapeutic use; D004322:Drainage; D004359:Drug Therapy, Combination; D004977:Ethambutol / Q000627:therapeutic use; D006801:Humans; D007538:Isoniazid / Q000627:therapeutic use; D008297:Male; D010996:Pleural Effusion / Q000175:diagnosis* / Q000188:drug therapy / Q000382:microbiology* / Q000628:therapy; D011718:Pyrazinamide / Q000627:therapeutic use; D012293:Rifampin / Q000627:therapeutic use; D014057:Tomography, X-Ray Computed; D014397:Tuberculosis, Pulmonary / Q000150:complications* / Q000175:diagnosis* / Q000188:drug therapy; D014398:Tuberculosis, Renal / Q000150:complications* / Q000175:diagnosis* / Q000188:drug therapy / Q000601:surgery
chemical_list: D000995:Antitubercular Agents; D011718:Pyrazinamide; D004977:Ethambutol; D007538:Isoniazid; D012293:Rifampin