A Rare Case of Multidrug-Resistant Tuberculosis Affecting the Pleura

Abstract

The majority of cases with tuberculous pleuritis have negative acid-fast bacilli (AFB) on smear microscopy, making the diagnosis difficult. This case report is based on the successful diagnosis and management of an extra-pulmonary (EP) multidrug-resistant tuberculosis (MDR-TB) patient with a history of lymphoma. Initial tests revealed a right-sided pleural effusion and thickening of the pleura. The closed pleural biopsy, pleural fluid histopathology, culture, and drug sensitivity testing (DST) report revealed Mycobacterium tuberculosis with isoniazid and rifampicin resistance. Based on the DST report, the patient was labeled as a case of MDR-TB and successfully managed with an individualized drug-resistant TB (DR-TB) regimen. With initial negative microscopy and GeneXpert MTB/RIF (Sunnyvale, CA: Cepheid Inc.) reports, this case demonstrated that DR-TB could exist even in the absence of risk factors. Furthermore, it also unveils the importance of line probe assays (LPAs) and culture in identifying MDR-TB. Lymphocytic/exudative pleural effusions and pleural biopsy specimens should be subjected early on to investigations like Xpert/MTB RIF, cultures, and genotypic DST to timely diagnose and treat DR-TB.

Infezioni in Medicina

“…An interesting case was published in 2022, describing data on the successful use of Xpert MBT/Rif in a patient with multidrug-resistant tuberculosis to isoniazid and rifampicin, who had a right-sided pleural effusion and pleural thickening. Scientists confirmed that in all cases of exudative or lymphocytic pleural effusion, pleural biopsy samples of patients should be examined by the Xpert MBT/Rif method, cultural analyzes, and a genotypic sensitivity test for early diagnosis and successful patient management [29]. A comparison of the complex morphological study of pleural fluid biopsies and the molecular analysis of GeneXpert MBT/Rif pleural biopsies for the purpose of confirming the diagnosis of tuberculosis with other similar scientific studies of the early detection of MBT in patients with pleurisy showed high diagnostic efficiency of the Xpert MBT/Rif analysis.…”

Multidrug-Resistant Moderate Tubercular Pleural Effusion: A Rare Case Presentation

“…Diagnosing tuberculous pleural effusions is challenging as acid-fast bacilli (AFB) microscopy and culture commonly produce negative results in 48-96% of cases. More than 90% of patients have to undergo thoracocentesis, which is commonly used to detect a lymphocytic, exudative pleural effusion; in contrast, less than 10% of patients undergo direct examination to detect AFB [ 3 ]. We need alternative diagnostic approaches as AFB staining and culture usually yield negative results.…”