title: [A case of tuberculous pleurisy developing contralateral effusion during anti-tuberculosis chemotherapy].
abstract: A 55-year-old woman was admitted to our hospital because of chest pain, fever, and right pleural effusion that was exudative and lymphocyte-dominant with a high level of adenosine deaminase (ADA). Since her blood QuantiFERON-TB 3G test (QFT) was positive, she was diagnosed with tuberculous pleurisy. After initiation of anti-tuberculosis chemotherapy with isoniazid, rifampicin, ethambutol, and pyrazinamide, her symptoms improved. Later, liquid culture of the pleural effusion turned positive for Mycobacterium tuberculosis. On the 18th day of treatment, her chest X-ray and computed tomography exhibited pleural effusion in a moderate amount in the left thorax, with subsiding pleural effusion in the right thorax. Thoracocentesis demonstrated that the left thorax effusion was also exudative and lymphocyte-dominant, with elevated QFT response and high ADA concentration, suggesting tuberculous pleurisy. Mycobacterium tuberculosis was detected in the culture of a left pleural biopsy specimen obtained by thoracoscopy. We assumed that the left pleural effusion was due to paradoxical worsening because (1) on admission no effusion or lung parenchymal lesion was detected in the left hemithorax, (2) on the 14th day of treatment she was afebrile without pleural effusion on both sides, and (3) the bacilli were sensitive to the drugs she had been taking regularly. We performed drainage of the left effusion and continued the same anti-tuberculosis drugs, which led to the elimination of all her symptoms and of the pleural effusion on both sides. In conclusion, paradoxical worsening should be included in the differential diagnosis when contralateral pleural effusion is detected during the treatment of tuberculosis.
authors.affiliation: Department of Respiratory Medicine, Center for Pulmonary Diseases, National Hospital Organization Tokyo National Hospital, Japan. taishii-tky@umin.ac.jp
authors.forename: Takashi
authors.initials: T
authors.lastname: Ishii
authors.forename: Yoshinori
authors.initials: Y
authors.lastname: Matsui
authors.forename: Naohiro
authors.initials: N
authors.lastname: Nagayama
authors.forename: Naoko
authors.initials: N
authors.lastname: Higaki
authors.forename: Kazuya
authors.initials: K
authors.lastname: Tone
authors.forename: Kei
authors.initials: K
authors.lastname: Kusaka
authors.forename: Mami
authors.initials: M
authors.lastname: Senoo
authors.forename: Haruyuki
authors.initials: H
authors.lastname: Ariga
authors.forename: Nobuharu
authors.initials: N
authors.lastname: Ohshima
authors.forename: Kimihiko
authors.initials: K
authors.lastname: Masuda
authors.forename: Hirotoshi
authors.initials: H
authors.lastname: Matsui
authors.forename: Shinji
authors.initials: S
authors.lastname: Teramoto
authors.forename: Akira
authors.initials: A
authors.lastname: Yamane
authors.forename: Atsuhisa
authors.initials: A
authors.lastname: Tamura
authors.forename: Hideaki
authors.initials: H
authors.lastname: Nagai
authors.forename: Shinobu
authors.initials: S
authors.lastname: Akagawa
authors.forename: Emiko
authors.initials: E
authors.lastname: Toyota
authors.forename: Shunsuke
authors.initials: S
authors.lastname: Shoji
authors.forename: Yutsuki
authors.initials: Y
authors.lastname: Nakajima
mesh_terms: D005260:Female; D006801:Humans; D008875:Middle Aged; D010996:Pleural Effusion / Q000209:etiology*; D014396:Tuberculosis, Pleural / Q000188:drug therapy