A complex case of eosinophilic pleural effusion: an unconventional response to anti-tubercular therapy
Keywords:Eosinophilic TB, Pleural effusion, Empirical anti-tubercular drugs, Case report
Eosinophilic tuberculosis (TB) is a rare form of TB characterized by the presence of eosinophils in pleural fluid. It remains an uncommon presentation and often poses a diagnostic challenge due to its resemblance to other conditions with eosinophilic pleural effusions. Here, we present a detailed case report of a 26-year-old female who presented with a two-week history of on-and-off fever, non-productive cough, and exertional dyspnea. Physical examination revealed absent air entry in the left infra-scapular and intra-axillary areas. Routine investigations and chest X-ray indicated a moderate left-sided pleural effusion with peripheral eosinophilia. Liver and kidney function tests were within the normal range. A left pleural tap was performed, and the pleural fluid analysis demonstrated an exudative effusion with predominantly eosinophils. Additional investigations, including ADA levels, Genexpert for TB, TB PCR, C-ANCA, P-ANCA, and total IgE levels, were performed to rule out other possible causes of eosinophilia, but the results were all negative or normal. No growth was observed on culture. Based on clinical history, examination findings, and investigation results, a diagnosis of eosinophilic TB was considered. The patient was started on empirical anti-tubercular drugs, which led to a favorable response and near-complete resolution of pleural effusion after 6 weeks of treatment. Regular follow-up and monitoring were conducted, and the patient completed a 6-month course of anti-tubercular treatment. This case report highlights the importance of considering eosinophilic TB in the differential diagnosis of pleural effusions, especially in young patients with no history of allergies or other underlying conditions.
Liao CH, Lai CC, Cheng CW, Huang YT, Hsu HL, Hsueh PR. Eosinophilic pleural effusion caused by Mycobacterium tuberculosis. Am J Trop Med Hyg. 2013;88(6):1211-5.
Park IN, Ryu JS, Choi JC, Shim TS, Lim JH, Park SJ. Eosinophilic pleural effusion associated with pulmonary tuberculosis: a report of nine cases. J Korean Med Sci. 2006;21(5):946-9.
Mhimbira FA, Bholla M, Mhalu G. Eosinophilia in patients with tuberculosis and HIV-1: a retrospective cohort analysis. BMC Infect Dis. 2018;18(1):255.
Kim YJ, Pack KM, Jeong ET. Eosinophilic pleural effusion with marked eosinophilia caused by Mycobacterium tuberculosis. Infect Chemother. 2014;46(3):181-5.
Sehgal IS, Dhooria S, Bal A, Agarwal R. Eosinophilic lung diseases: a review. J Assoc Chest Physicians. 2017;5(1):24-35.
Rom WN, Garay SM. Tuberculosis. 2nd ed. Lippincott Williams and Wilkins. 2004.
Centers for Disease Control and Prevention (CDC). Treatment of tuberculosis. MMWR Recomm Rep. 2003;52(RR-11):1-77.
Wang JY, Lee LN, Hsueh PR. Factors changing the manifestation of pulmonary tuberculosis. Int J Tuberc Lung Dis. 2005;9(7):777-83.