Clinical Profile of Patients with Tuberculous Pleural Effusion.

Background: The diagnosis of tuberculous pleural effusion is by demonstration of the causative organism that is mycobacterium tuberculosis. Biochemical investigations like pleural fluid ADA which is shed by the lymphocytes is very non-specific. It is raised in other conditions like empyema, lymphoreticular malignancies, bronchogenic carcinoma, rheumatoid arthritis and tuberculosis (TB). The aim is to study the clinical profile of patients with tuberculous pleural effusion. Methods: A study was conducted on 60 patients at a public hospital. The patients were asked a detailed history with regards to chest pain and its nature, dyspnoea, cough, fever and constitutional symptoms. Also detailed past history about pleural tuberculosis and pleural aspiration/ICD insertion and AKT history was taken. Patients were then subjected to a clinical examination, which included a thorough general examination and detailed respiratory system examination in terms of decrease in movements of the chest on any particular side, bulge on any particular side, stony dull note on percussion, presence of shifting dullness, and decrease in breath sounds with decrease in vocal resonance. Patients were later subjected to an X ray examination for confirmation of the diagnosis. In some patients ultrasonography of the chest was done especially in loculated effusion for point marking. After confirming the diagnosis, patients were subjected to a transthoracic pleural aspiration using all aseptic precautions. Results: Most of the patients belonged to age group between 15-45 years i.e. 47 (78.33%). Thus the incidence in elderly age group was found to be less (21.67%). The symptom analysis of 60 patients revealed that almost all these patients had chest pain as predominant symptom (98%) followed by dry cough and dyspnoea on exertion, 98% and 88% respectively. The constitutional symptom such as loss of appetite was present in 93% of patients and weight loss in 85% of patients. The average duration of symptoms was 56.57 days. Right sided pleural effusion was more common than left side. There were no cases of bilateral pleural effusions at any given point of time during study period. Conclusion: Most common presentation of tuberculous pleural effusion was chest pain. Right sided pleural effusion was more common than left side.

Wegener’s Granulomatosis: Are We Still Missing It.

We report the case of an 18-year-old female who was mis-diagnosed as a smear-negative pulmonary tuberculosis and advised standard antituberculosis treatment. She later presented with clinio-radiological worsening and thrombosis of superficial veins of the lower extremity. Cytoplasmic anti-neutrophil cytoplasmic antibody and computed tomographyguided lung biopsy confirmed the diagnosis of Wegener’s granulomatosis. The rare association of superficial vein thrombosis with lung manifestation is highlighted here as also the need for a high index of clinical suspicion to avoid a missed or delayed diagnosis.