Tuberculous pleural effusion in a school-age child: diagnostic evaluation of a case with no known tuberculosis contact

Abstract

Introduction: Pleural tuberculosis is a relatively rare form of extrapulmonary tuberculosis (TB) that, although more common in endemic areas, can be presented even in children without known risk factors. Early diagnosis is crucial for proper management. This case describes a child with pleural tuberculosis without obvious risk factors for TB. Materials and Methods: A 7-year-old boy presented with fever, chest pain, and respiratory difficulty. Initial microbiological studies (PCR, acid-fast bacillus smear, cultures) were negative, but analysis of pleural fluid showed a lymphocytic predominance and high adenosine deaminase (ADA) levels, suggesting pleural tuberculosis. Tuberculin skin test and IGRA confirmed the diagnosis. Results: The diagnosis was confirmed through elevated ADA levels, a positive tuberculin skin test (14 mm), and positive IGRA results. Management included antituberculosis treatment, with a favorable clinical outcome. Conclusions: This case highlights the importance of considering pleural tuberculosis in children, even in the absence of known tuberculosis exposure. A comprehensive diagnostic approach is essential to confirm pleural TB and guide appropriate treatment.