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Pleural tuberculosis: a key differential diagnosis for pleural thickening, even without obvious risk factors for tuberculosis in a low incidence setting
  1. Keir Elmslie James Philip,
  2. Onn Min Kon,
  3. Mary Roddie,
  4. Clare Ross
  1. Department of Respiratory Medicine, Imperial College Healthcare NHS Trust, London, UK
  1. Correspondence to Dr Keir Elmslie James Philip, kejphilip{at}


We report the case of a 64-year-old woman, presenting with pleuritic chest pain and weight loss. She had a previous history of breast malignancy and no clear risk factors for tuberculosis (TB). Initial investigations showed a right-sided pleural effusion and pleural thickening suggestive of malignancy, which would have been in keeping with the clinical presentation. Initial pleural biopsy showed features suggestive of possible TB infection, though no growth on cultures. A repeat biopsy was negative on initial microscopy, but was culture positive for Mycobacterium tuberculosis, also identifying isoniazid resistance. This case highlights that TB remains an important differential even in the absence of classical risk factors, and illustrates the diagnostic challenges it poses. It also highlights the value of culture positivity in identification of drug resistance and facilitation of appropriate treatment.

  • tb and other respiratory infections
  • drugs: respiratory system
  • tuberculosis

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  • Contributors OMK, MR and CR were all involved directly with the patients care. All authors contributed to planning the article. KEJP drafted the article, with OMK, MR and CR making significant comments and contributions to multiple drafts. All authors have agreed on the final draft.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.