Kam-Yung Lau, MD F.C.C.P.([unkeyabl...

Kam-Yung Lau, MD F.C.C.P.([unkeyable])

Tuberculous pleural effusions are characterized through the absence or paucity of mesothelial small rooms Two cases of pleural tuberculosis are reported in which significant numbers of mesothelial lonely dwellings were found.

Pleural effusion may come about at any stage of active tuberculosis.[1] The fluid is generally an exudate,[2] characterized through a predominance of lymphocytes and a paucity or absence of mesothelial cells[3-5] In fact, it has been conclud that the appearance of numerous mesothelial cells almost prohibits a diagnosis of tuberculosis. This report belong tos two cases of tuberculous pleural effusion in which significant numbers of mesothelial small cavitys were found.

CASE REPORTS

Case 1

A 24-year-old previously healthy black man was admitted to our hospital with a nonproductive cough and right-sided pleuritic pain of three days' duration. There was no history of febrile affection chills, night sweats, weight los or position to tuberculosis. Physical examination revealed decreased breath unimpaireds and dullness to percussion in the right lower chest posteriorly. A chest roentgenogram showed enlarged right paratracheal lymph nodes and a right pleural effusion (Fig 1) Thoracentesis yielded 500 ml of orange, obscure fluid with RBC 9,240/cu mm and WBC 2280/cu mm of which 21 percent were neutrophils, 64 percent lymphocyte 12 percent mononuclear enclosed spaces and 3 percent mesothelial cells; the protein was 55 g/dL and the LDH 362 IU/L. Microscopic examination of stained specimens of the fluid and sputum disclosed no AFB, fungi, or other microorganisms. Tuberculin skin touchstone was positive with an induration of 13 mm A repeat thoracentesis three days later again revealed r lurid fluid with RBC, 21,700/cu mm and WBC 2600/cu mm with 20 percent neutrophils, 3 percent eosinophils, 65 percent lymphocyte 6 percent monocytes, and 6 percent mesothelial small cavitys Cytologic examination disclosed numerous mesothelial small rooms (Fig 2). Pleural biopsy revealed chronic pleuritis with no granuloma seen Acid-fast stain was negative.

the same week after admission, a repeat chest roentgenogram showed increasing pleural effusion and enlarging mediastinal lymphadenopathy. A thoracotomy was performed, and multiple nodular lesions were construct studding both parietal and visceral pleura. Biopsies of these lesions revealed caseating granulomas, which, in succession Ziehl-Neelsen stain, demonstrated the port of AFB. Antituberculosis medications were started, and the patient be agreeable toed A chest roentgenogram done couple months later showed resolution of the pleural effusion and mediastinal adenopathy. agricultures of both needle and interpret biopsy specimens subsequently grew Mycobacterium tuberculosis.

CASE 2

A 60-year-old man was admitted because of a left pleural effusion. The patient had a history of alcoholic liver disease and upper gastrointestinal bleeding from esophageal varices. Five month earlier, he had undergone endoscopic variceal sclerotherapy. A left pleural effusion was ascertained by a routine chest roentgenogram. Pleural fluid studies showed a LDH value of 67 IU/L; a protein even of 1.4 gm/dL; RBC, 20900/cu mm; and WBC 60/cu mm with 54 percent neutrophils, 13 percent lymphocyte 17 percent monocytes and 16 percent mesothelial small cavitys A simultaneous serum LDH valve was 141 IU/L and serum protein value was 55 g/dl The AFB stain and refinement were negative. He underwent brace more sclerotherapies over the nearest two months. During that time, the pleural effusion was noted to increase in size, further repeat thoracocenteses consistently yielded transudative fluids.

The patient was in stable health until three days before admission when he unraveled left pleuritic pain. Cough febrile affection chills, night sweats, or frontage to tuberculosis was denied. in succession examination, he was noted to have diminished breath healthys in the left posterior chest and no ascites. A large left pleural effusion was at hand on the chest roentgenogram.

Thoracentesis yielded sanguinary fluid containing RBC, 900,000/cu mm; and WBC 120/cu mm with 62 percent neutrophils, 18 percent lymphocyte 12 percent mononuclear solitary abode; squalids and 8 percent mesothelial confined apartments The protein of the fluid was 26 g/dl and LDH value, 99 IU/L. A simultaneous serum protein value was 66 g/dl and LDH flat 154 IU/L. Cultures for bacteria, fungus, and AFB, and cytology were negative. A pleural biopsy revealed nonspecific chronic inflammation and the AFB stain was negative; however, Mycobacterium tuberculosis was eventually cultur from the biopsy specimen.

The patient subsequently died of complications of alcoholism.

DISCUSSION

Tuberculosis remains an important cause of pleural effusion. A latter study revealed changes in the patterns of pleural tuberculosis: it has become a disease of older adults; it may be seen in the two primary and postprimary disease; and unlike previous reports of highly lymphocytic effusions, sole 62 percent of the reported patients had more than 50 percent lymphocyte upon initial exam of their pleural fluid.[1]