Case Report: tuberculous pleurisy mimicking mesothelioma in a 37-year-old Chinese woman

Our plain-English summary of Case Report: tuberculous pleurisy mimicking mesothelioma in a 37-year-old Chinese woman, by X. Liu, T. Cao, C. Mei, et al (BMC Infectious Diseases, 2025).

The study

• Authors: X. Liu, T. Cao, C. Mei, S. Chen, C. Yang
• Journal: BMC Infectious Diseases
• Published: 2025;26(1):191
• Type of article: Case report
• Read it: PubMed · Publisher · Free full text

Abstract

BACKGROUND: Tuberculosis is a great mimicker of infectious as well as non-infectious diseases, such as cancer. Tuberculous pleurisy is one of the most common extrapulmonary tuberculosis manifestations, and it is difficult to diagnose. CASE PRESENTATION: We describe a case of tuberculous pleurisy presenting with diffuse bilateral pleural thickening. This 37 year old woman had 1-year history of intermittent shortness of breath for which CT thorax was obtained at community hospital that showed bilateral pleural thickening. Increased fluorodeoxyglucose uptake along nodular bilateral pleural thickenings and in the hilar lymph nodes mimicked mesothelioma. Subsequent acid-fast staining of the pleural biopsy specimen was positive. The patient received antituberculosis therapy for 6 months, with clearly improved pleural lesions on chest computed tomography. CONCLUSION: In relatively young individuals presenting with diffuse pleural thickening, even when there are minimal intermittent subjective symptoms, the possibility of tuberculosis should not be ignored.

In plain English

This case report described a 37-year-old Chinese woman referred on 30 November 2021 after a routine chest CT showed diffuse thickening of the pleura (the lining around the lungs) on both sides. The patient had a 1-year history of intermittent shortness of breath on exertion and 9 years of diabetes, no occupational exposure to asbestos, silica or other fibrogenic substances, and a father treated for tuberculosis (TB) in 2021. PET/CT showed increased FDG uptake along nodular pleural thickening and in hilar lymph nodes, and mesothelioma or pseudomesotheliomatous carcinoma was suspected. A tuberculin skin test and interferon-gamma release assay were positive. A left pleural needle biopsy showed fibrous tissue with mild necrosis and positive acid-fast staining. No clear mesothelial proliferation or tumor was seen, and immunohistochemical stains were not done. Xpert testing detected extremely low levels of TB bacteria. After four-drug TB treatment, CT on 8 May 2022 showed improved pleural lesions. The authors concluded that TB should be considered in relatively young people with diffuse pleural thickening even when symptoms are minimal.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: case report (single patient)
• Who was studied: One 37-year-old Chinese woman referred to Wuhan Pulmonary Hospital, China, on 30 November 2021 after abnormal chest CT findings at a routine health checkup
• Exposure: No asbestos exposure: the patient had no history of occupational exposure to asbestos, silica, or other fibrogenic substances. The condition studied was tuberculous pleurisy (TB infection of the pleura).
• Main results:
  • The patient had a 1-year history of intermittent shortness of breath when physical activity increased.
  • The patient had a 9-year history of diabetes mellitus.
  • The patient's father had been treated for smear-positive pulmonary TB (in June 2021).
  • Chest CT showed diffuse bilateral pleural thickening with mild bilateral pleural effusion; the thickest point was approximately 20 mm.
  • PET/CT showed increased FDG uptake along nodular bilateral pleural thickening and in the hilar lymph nodes.
  • On the basis of the imaging, mesothelioma or pseudomesotheliomatous carcinoma were suspected.
  • The tuberculin skin test and interferon-gamma release assay were positive.
  • CT-guided left pleural biopsy showed proliferative fibrocollagenous tissue with mild cellular necrosis, and acid-fast staining of the specimen was positive.
  • PCR and TB culture of the biopsy needle rinsing solution were negative.
  • Xpert testing of the acid-fast-positive tissue slices detected extremely low levels of Mycobacterium tuberculosis (Mtb), with no rifampicin resistance.
  • No clear proliferation of mesothelial cells or tumor lesions was seen in the biopsy.
  • Immunohistochemical studies (WT-1, pancytokeratin, calretinin, CK5/6, TTF-1, p40) were not performed.
  • Treatment with isoniazid, rifampicin, pyrazinamide and levofloxacin led to clinical improvement. Ethambutol was left out because of diabetic retinopathy.
  • Chest CT on 8 May 2022 showed improved pleural lesions compared with previous images.
• The authors' conclusion: The authors concluded that TB should be considered in relatively young individuals presenting with diffuse pleural thickening even when there are minimal intermittent subjective symptoms. They also stated that in TB-endemic countries the possibility of false-positive FDG PET/CT results should be considered.

Topics

The National Library of Medicine indexes this study under subjects our site covers: Mesothelioma.

Medical terms in this study, explained in our Lexicon: Tuberculous pleurisy, Mesothelioma, Bilateral, Pleural Thickening, Thorax, Hilar Lymph Nodes, Pleural Biopsy, Diffuse Pleural Thickening.

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