Tuberculosis, despite all the research and technological inputs developed in recent years, remains one of the most frequent causes of pleural effusion, especially in developing countries such as Brazil. In immunocompetent individuals, pleural tuberculosis is the most common form of extrapulmonary tuberculosis. The diagnosis of this form of the disease continues to be the detection of Mycobacterium tuberculosis in pleural fluid, or in pleural biopsy samples, either by microscopy and / or culture, and the histological existence of granulomas in the pleura, a valid instrument for the determination of the disease , although the agent is not isolated. We present in this paper the report of a male patient, 76 years old, referred to the Public General Hospital of Palmas (HGPP) in december 2018, with clinic suggestive of Tuberculosis and absence of isolation of M. tuberculosis in a classical research – acid fast bacilli (AFB) and cultures. The visualization of the granulomatous reaction in the pleura, in association with the clinic, proved to be safe for establishing the diagnosis and conduct. Keywords: tuberculosis; pleural tuberculosis; Mycobacterium tuberculosis; tuberculosis diagnosis. RESUMO A tuberculose, apesar de todas as pesquisas e insumos tecnológicos desenvolvidos nos últimos anos, continua sendo uma das causas mais frequentes de derrame pleural, especialmente em países em desenvolvimento como o Brasil. Em indivíduos imunocompetentes, a tuberculose pleural é a forma mais comum de tuberculose extrapulmonar. O diagnóstico desta forma da doença continua sendo a detecção de Mycobacterium tuberculosis em líquido pleural, ou em amostras de biópsia pleural, seja por microscopia e / ou cultura, tendo-se demonstrado a existência histológica de granulomas na pleura, instrumento válido para determinação da doença, ainda que não isolado o agente. Apresentamos neste trabalho o relato de um paciente, masculino, 76 anos, encaminhado ao Hospital Geral Público de Palmas (HGPP) em dezembro de 2018, com clínica sugestiva de Tuberculose e ausência de isolamento de M. tuberculosis em algoritmo clássico de investigação – pesquisa de bacilo álcool- ácido resistente (BAAR) e culturas. A visualização de reação granulomatosa em pleura, em associação com a clínica, se revelou segura para estabelecimento do diagnóstico e conduta. Palavras-chave: tuberculose; tuberculose pleural; Mycobacterium tuberculosis; diagnóstico de tuberculose.
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