scholarly journals Mycoplasma pneumoniae infection mimicking tuberculous pleurisy in a young woman: a case report and literature review

2020 ◽  
Vol 48 (4) ◽  
pp. 030006052091870
Author(s):  
Peng Wen ◽  
Min Wei ◽  
Xue Guo ◽  
Yu-Rong Xu
Keyword(s):  
Pleural Effusion ◽  
Adenosine Deaminase ◽  
Mycoplasma Pneumoniae ◽  
Left Lung ◽  
Lower Lobe ◽  
Anterior Lobe ◽  
Immunoglobulin M ◽  
Recent Infection ◽  
History Of ◽  
Tuberculous Pleurisy

A 30-year-old woman was admitted to a different hospital with a 2-day history of fever, cough, and expectoration. She had a history of left pulmonary tuberculosis 8 years previously. Chest computed tomography showed an infiltrate in the inferior lobe of the left lung and spot-like calcifications in the anterior lobe of the upper left lobe and lower lobe of the left lung. After antibacterial treatment, the patient’s condition deteriorated and she developed significant pleural effusion on the left side. The pleural effusion assay showed a lymphocyte-predominant exudate with a significantly increased adenosine deaminase level. The patient was transferred to our hospital with a suspected diagnosis of tuberculous pleuritis. A serum test for Mycoplasma pneumoniae-specific immunoglobulin M was positive. Because of the limitations of this test in determining the occurrence of recent infection, a thoracoscopic pleural biopsy was performed, and M. pneumoniae DNA was detected in the biopsy tissue using M. pneumoniae-specific polymerase chain reaction. Thus, the patient was diagnosed with M. pneumoniae-related parapneumonic effusion. Clinicians must be aware of the usefulness and limitations of a high adenosine deaminase level and know that lymphocyte predominance in pleural effusion does not always indicate tuberculous pleurisy, especially in areas of high tuberculosis prevalence.

scholarly journals Recurrent pleural effusion in a young woman: calcifying fibrous tumour of the pleura

2018 ◽  
pp. bcr-2018-226282 ◽  
Author(s):  
Joy C Edlin ◽  
Lorna Elizabeth Donovan ◽  
Clare Alexander ◽  
Robin Kanagasabay
Keyword(s):  
Pleural Effusion ◽  
Thoracoscopic Surgery ◽  
Lower Lobe ◽  
Chest Ct ◽  
Left Hemithorax ◽  
Contrast Enhanced ◽  
History Of ◽  
Rare Benign Tumour ◽  
Recurrent Pleural Effusion ◽  
Complete Collapse

We present the case of a 23-year-old woman with a long-standing history of recurrent left-sided pleural effusion unrelated to her menstrual cycle. At her last presentation, non-contrast-enhanced chest CT showed a pleural effusion and a lower left hemithorax mass, both large enough to cause complete collapse of the lower lobe and partial collapse of the upper lobe. Thoracoscopic surgery revealed a multilobulated mass originating from the dome of the diaphragm with pleural deposits. Histopathology diagnosed this as a calcifying fibrous tumour of the pleura, a rare benign tumour with excellent prognosis when completely excised.

scholarly journals A Case of Pneumonia due to Mycoplasma pneumoniae Accompanying High Adenosine Deaminase Activity in Pleural Effusion

1992 ◽  
Vol 66 (7) ◽  
pp. 995-997
Author(s):  
Shiro TOKISAWA ◽  
Junichi HONDA ◽  
Yoshiko TOKISAWA ◽  
Yozo AKASHI ◽  
Tetsuo ODA ◽  
...  
Keyword(s):  
Pleural Effusion ◽  
Adenosine Deaminase ◽  
Mycoplasma Pneumoniae ◽  
Adenosine Deaminase Activity

Rare complication of a type IV paraoesophageal hiatal hernia in a Marfan syndrome patient

2021 ◽  
Vol 14 (4) ◽  
pp. e239641
Author(s):  
Lachlan Hou ◽  
Sunita Dhanda ◽  
Dan Xu
Keyword(s):  
Aortic Dissection ◽  
Hiatal Hernia ◽  
Marfan Syndrome ◽  
Rare Complication ◽  
Left Lung ◽  
Lower Lobe ◽  
Type Iv ◽  
History Of ◽  
Medical Histories ◽  
Long Term Prognosis

A 77-year-old female patient with Marfan syndrome presented with a 1-week history of worsening malaise and poor appetite. This was associated with a dramatic unintentional loss of weight as well as shortness of breath worsened by exertion. She has significant medical histories of a hiatal hernia and chronic type B aortic dissection. CT scan of the chest was able to confirm a type IV paraoesophageal hiatal hernia compressing on the lower lobe of her left lung without any progression of her aortic dissection. As surgical intervention was contraindicated in light of her advanced age and comorbidities, she was managed conservatively with a clinically satisfied outcome in the short term. Her long-term prognosis, however, is still poor with a high mortality of 1 and 5 years.

scholarly journals Tension hydrothorax in a patient with SARS-CoV-2 pneumonitis and pleural Mycobacterium tuberculosis

2021 ◽  
Vol 14 (7) ◽  
pp. e243760
Author(s):  
Mohsin F Butt ◽  
Maggie Symonds ◽  
Ruhaid Khurram
Keyword(s):  
Emergency Department ◽  
Mycobacterium Tuberculosis ◽  
Pleural Effusion ◽  
Respiratory Distress ◽  
Chest Radiograph ◽  
Left Lung ◽  
Pleural Effusions ◽  
Mediastinal Shift ◽  
History Of ◽  
The Right

Unilateral pleural effusions are uncommonly reported in patients with SARS-CoV-2 pneumonitis. Herein, we report a case of a 42-year-old woman who presented to hospital with worsening dyspnoea on a background of a 2-week history of typical SARS-CoV-2 symptoms. On admission to the emergency department, the patient was severely hypoxic and hypotensive. A chest radiograph demonstrated a large left-sided pleural effusion with associated contralateral mediastinal shift (tension hydrothorax) and typical SARS-CoV-2 changes within the right lung. She was treated with thoracocentesis in which 2 L of serosanguinous, lymphocyte-rich fluid was drained from the left lung pleura. Following incubation, the pleural aspirate sample tested positive for Mycobacterium tuberculosis. This case demonstrates the need to exclude non-SARS-CoV-2-related causes of pleural effusions, particularly when patients present in an atypical manner, that is, with tension hydrothorax. Given the non-specific symptomatology of SARS-CoV-2 pneumonitis, this case illustrates the importance of excluding other causes of respiratory distress.

scholarly journals Rapid Detection of Cell-Free Mycobacterium tuberculosis DNA in Tuberculous Pleural Effusion

2017 ◽  
Vol 55 (5) ◽  
pp. 1526-1532 ◽  
Author(s):  
Nanying Che ◽  
Xinting Yang ◽  
Zichen Liu ◽  
Kun Li ◽  
Xiaoyou Chen
Keyword(s):  
Mycobacterium Tuberculosis ◽  
Pleural Effusion ◽  
Adenosine Deaminase ◽  
Direct Evidence ◽  
Extrapulmonary Tuberculosis ◽  
Content Type ◽  
Mycobacterial Culture ◽  
Dna Assay ◽  
Tuberculous Pleurisy ◽  
First Time

ABSTRACT Tuberculous pleurisy is one of the most common types of extrapulmonary tuberculosis, but its diagnosis remains difficult. In this study, we report for the first time on the detection of cell-free Mycobacterium tuberculosis DNA in pleural effusion and an evaluation of a newly developed molecular assay for the detection of cell-free Mycobacterium tuberculosis DNA. A total of 78 patients with pleural effusion, 60 patients with tuberculous pleurisy, and 18 patients with alternative diseases were included in this study. Mycobacterial culture, the Xpert MTB/RIF assay, the adenosine deaminase assay, the T-SPOT.TB assay, and the cell-free Mycobacterium tuberculosis DNA assay were performed on all the pleural effusion samples. The cell-free Mycobacterium tuberculosis DNA assay and adenosine deaminase assay showed significantly higher sensitivities of 75.0% and 68.3%, respectively, than mycobacterial culture and the Xpert MTB/RIF assay, which had sensitivities of 26.7% and 20.0%, respectively ( P < 0.01). All four of these tests showed good specificities: 88.9% for the adenosine deaminase assay and 100% for the remaining three assays. The T-SPOT.TB assay with pleural effusion showed the highest sensitivity of 95.0% but the lowest specificity of 38.9%. The cell-free Mycobacterium tuberculosis DNA assay detected as few as 1.25 copies of IS 6110 per ml of pleural effusion and showed good accordance of the results between repeated tests ( r = 0.978, P = 2.84 × 10 −10 ). These data suggest that the cell-free Mycobacterium tuberculosis DNA assay is a rapid and accurate molecular test which provides direct evidence of Mycobacterium tuberculosis etiology.

scholarly journals Diagnostic value of pleural fluid adenosine deaminase among the patients with pleural tuberculosis

2019 ◽  
Author(s):  
Fariborz Rousta ◽  
Mohsen Sokouti ◽  
Samad Beheshty Rouy ◽  
Sina Parsay
Keyword(s):  
Pleural Effusion ◽  
Adenosine Deaminase ◽  
Pleural Fluid ◽  
Predictive Value ◽  
Pathology Report ◽  
Tuberculous Lymphadenitis ◽  
Pleural Tuberculosis ◽  
Multiple Biopsies ◽  
Tuberculous Pleurisy ◽  
Exudative Pleural Effusion

Abstract Purpose Extra-pulmonary tuberculosis occurs in about 10-20% of patients most commonly as tuberculous lymphadenitis or pleural effusion. Pleural fluid Adenosine deaminase (ADA) activity considered as a useful biomarker for detecting pleural tuberculosis. The purpose of this study was to evaluate the diagnostic accuracy of pleural fluid adenosine deaminase level in patients with pleural tuberculosis. Methods In this cross-sectional study, 113 patients with exudative pleural effusion with unknown underlying diagnosis, were enrolled. Physical examination, chest CT, measurement of ADA level of pleural fluid, direct thoracoscopic examination, and biopsy of pleura were performed for all individuals. Results The diagnosis of tuberculous pleurisy was established in 40 individuals regarding the pathology report of biopsy samples. The mean ADA level of the TB and the non-TB group was 39.90±22.93 IU/L and 30.74±38.27 IU/L respectively, which was not statistically significant (P-value=0.167). Sensitivity, specificity, positive predictive value, and negative predictive value of ADA test were 35%, 86.30%, 58.33%, and 70.79%, respectively. Conclusion Based on low sensitivity and specificity of ADA test, in patients with unexplained exudative pleural effusion especially in those who were suspicious for tuberculous pleurisy, despite the low level of ADA, direct thoracoscopic pleural observation and multiple biopsies of pleura is highly recommended.

scholarly journals Mycoplasma pneumoniae Pneumonia with Worsening Pleural Effusion Despite Treatment with Appropriate Antimicrobials: Case report

2018 ◽  
Vol 18 (2) ◽  
pp. 239 ◽  
Author(s):  
Kowthar S. Hassan ◽  
Ghalib Al-Khadouri
Keyword(s):  
Case Report ◽  
Pleural Effusion ◽  
Mycoplasma Pneumoniae ◽  
Antimicrobial Agents ◽  
Community Acquired Pneumonia ◽  
University Hospital ◽  
Medicine Department ◽  
Sultan Qaboos University ◽  
History Of ◽  
Mycoplasma Pneumoniae Pneumonia

Mycoplasma pneumoniae is a common cause of community-acquired pneumonia. As M. pneumoniae pneumonia is usually a mild and self-limiting disease, complications such as pleural effusion occur only rarely. We report a 22-year-old woman who presented to the Emergency Medicine Department of the Sultan Qaboos University Hospital, Muscat, Oman, in 2017 with an eight-day history of fever associated with coughing, chills and rigors. She was diagnosed with M. pneumoniae pneumonia, but subsequently developed pleural effusion which worsened despite treatment with appropriate antimicrobials. The pleural effusion required drainage, which revealed that it was of the more severe exudative type. Following drainage, the patient improved dramatically. She was discharged and advised to continue taking antibiotics.Keywords: Mycoplasma pneumoniae; Bacterial Pneumonia; Pleural Effusion; Antimicrobial Agents; Drainage; Case Report; Oman.

Diagnostic value of adenosine deaminase in tuberculous pleural effusion: a meta-analysis

2003 ◽  
Vol 40 (4) ◽  
pp. 374-381 ◽  
Author(s):  
Masashi Goto ◽  
Yoshinori Noguchi ◽  
Hiroshi Koyama ◽  
Kenji Hira ◽  
Takuro Shimbo ◽  
...  
Keyword(s):  
Pleural Effusion ◽  
Adenosine Deaminase ◽  
Pleural Fluid ◽  
Meta Analysis ◽  
Cochrane Library ◽  
Pleural Biopsy ◽  
Tuberculous Pleural Effusion ◽  
Test Characteristics ◽  
Tuberculous Pleurisy ◽  
Gold Standards

Background: Many studies have investigated the usefulness of adenosine deaminase activity (ADA) in pleural fluid for the early diagnosis of tuberculous pleurisy. To summarize the diagnostic characteristics of ADA we undertook a meta-analysis using a summary receiver operating characteristic (SROC) curve method. Methods: Data sources were MEDLINE (1966-1999), the Cochrane Library and bibliographies of review and original articles. Studies were included if the absolute numbers of true positive, false negative, true negative and false positive observations were available or could be derived from the data presented; gold standards were described explicitly; and the criteria for a positive ADA result were reported. We constructed an SROC curve based on these extracted data to estimate the test characteristics. Results: Forty articles were available for analysis. The gold standards used were pleural biopsy histology, microbiological examination of pleural fluid, pleural biopsy and sputum and the patient's clinical course or combinations of these. The sensitivity of ADA reported in the articles ranged from 47·1% to 100% and the specificity from 50·0% to 100%. The summary measure of test characteristics derived from the SROC curve was 92·2% for both sensitivity and specificity. Conclusions: The test performance of ADA in tuberculous pleural effusion is reasonably good. Measurement of pleural ADA is thus likely to be a useful diagnostic tool for tuberculous pleurisy.

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