Empyema necessitans mimicking mesothelioma; unusual presentation of active pulmonary TB in immuno-competent state

Our plain-English summary of Empyema necessitans mimicking mesothelioma; unusual presentation of active pulmonary TB in immuno-competent state, by A.M.H. Dirie, H. Özdemir, A.M. Hussein, et al (Annals of Medicine and Surgery, 2022).

The study

• Authors: A.M.H. Dirie, H. Özdemir, A.M. Hussein, A.M. Warsame
• Journal: Annals of Medicine and Surgery
• Published: 2022;75:103464
• Type of article: Case report
• Cited by: 2 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

•This case presented with very rare feature of active Pulmonary TB.•It denotes that Empyema Necessitans can mimick mesothelioma.•Unusual CT findings of Empyema Necessitans.•It states importance of induced sputum for TB diagnosis.•We recommend to test induced sputum for extrapulmonary tuberculosis to halt the spread of TB in the communities.

© 2022 The Authors.

In plain English

This was a case report from a hospital in Mogadishu, Somalia. It described one previously healthy 18-year-old man who came in with a right front chest-wall lump that had grown quickly, and a mild fever for two weeks. Blood tests for HIV, hepatitis B and hepatitis C were negative. A chest CT scan showed solid lesions on the lining of the right lung (the pleura), the largest 2.5 cm, which suggested cancer. It also showed a 4 cm lesion reaching into the chest muscle. Surgeons opened and drained it. The fluid showed no cancer cells but tested positive for tuberculosis bacteria. A sputum test confirmed tuberculosis that the drug rifampicin could treat. Standard tuberculosis drugs were started, and one month later he had no symptoms. The article does not mention asbestos. The authors concluded that this collection of tuberculosis infection spreading from the lung lining into the chest wall (empyema necessitans) looked like mesothelioma because of the scattered pleural lesions. They added that it can be the only sign of active lung tuberculosis in people with a normal immune system.

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 (a single patient)
• Who was studied: One previously healthy 18-year-old male seen at the outpatient department of a training and research hospital in Mogadishu, Somalia; no date of presentation is given
• Exposure: No asbestos or occupational exposure is described. The condition studied was tuberculosis infection (Mycobacterium tuberculosis). The patient denied lung disease, smoking, qat chewing, alcoholism and vaping.
• Main results:
  • In this patient, chest CT showed solid pleural lesions in the right side of the chest. The largest measured 2.5 cm and the lesions were read as indicating malignancy. A 4 cm low-density lesion extended into the right chest (pectoral) muscle.
  • In this patient, the drained fluid grew no bacteria but tested positive for tuberculosis bacteria (acid-fast bacilli test), and fluid cytology was negative for malignancy
  • In this patient, a sputum test (PCR/GeneXpert) at the national TB center confirmed rifampicin-sensitive Mycobacterium tuberculosis
  • In this patient, blood tests for HIV, hepatitis B surface antigen and hepatitis C were negative
  • After first-line anti-tuberculosis drugs were started, the patient had no symptoms at follow-up one month later, and the incision had healed
• The authors' conclusion: The authors concluded that this was a case of active lung tuberculosis without symptoms that presented as empyema necessitans and mimicked mesothelioma because of scattered pleural lesions. They also concluded that empyema necessitans can be the only clinical sign of active lung tuberculosis in people with a normal immune system.

Topics

Medical terms in this study, explained in our Lexicon: Empyema, Mesothelioma, Sputum.

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