Malignant pleural mesothelioma in a young adult without asbestos exposure: a case report highlighting diagnostic pitfalls and literature review

Our plain-English summary of Malignant pleural mesothelioma in a young adult without asbestos exposure: a case report highlighting diagnostic pitfalls and literature review, by R. Chauhan, K. Fnu, B. Sahil, et al (Annals of Medicine and Surgery, 2026).

The study

• Authors: R. Chauhan, K. Fnu, B. Sahil, A. Kaur Chug, M. Mohammad Ali Baig, M. Umar, I. Osman Abufatima
• Journal: Annals of Medicine and Surgery
• Published: 2026;88(5):2960-2964
• Type of article: Case report
• Read it: PubMed · Publisher · Free full text

Abstract

Background: Malignant pleural mesothelioma (MPM) is a rare and aggressive malignancy typically associated with asbestos exposure in older adults. Its occurrence in young individuals without asbestos exposure poses significant diagnostic challenges, particularly in tuberculosis-endemic regions.

Case Presentation: We report the case of a 23-year-old man with no history of asbestos exposure who presented with progressive pleuritic chest pain, dyspnea, fever, and weight loss. Initial evaluation suggested tuberculous pleuritis, and empirical therapy was initiated. Imaging revealed diffuse nodular pleural thickening with loculated effusion. Ultrasound-guided pleural biopsy demonstrated epithelioid MPM, confirmed by immunohistochemical positivity for calretinin and WT-1 with TTF-1 negativity. Despite supportive care, the patient experienced rapid clinical deterioration and died within 1 week of histopathological confirmation. Genetic testing for BAP1 mutation was recommended but could not be performed due to rapid disease progression.

Conclusion: This case underscores the importance of considering MPM in the differential diagnosis of pleural effusion in young adults, even in the absence of asbestos exposure. Early pleural biopsy and immunohistochemical evaluation are essential to avoid diagnostic delay, particularly in tuberculosis-endemic settings.

Copyright © 2026 The Author(s). Published by Wolters Kluwer Health, Inc.

In plain English

This case report described a 23-year-old man from rural Bihar, India, with no prior medical illness, no asbestos exposure, and no family history of cancer. The patient had about 4 months of right-sided chest and lumbar pain, worsening breathlessness, intermittent fever, poor appetite and about 1.5 kg of weight loss. Doctors first suspected tuberculous pleuritis (tuberculosis affecting the lining around the lung), and the authors linked the diagnostic delay to that first anti-tuberculosis treatment. Scans showed diffuse nodular thickening of the right pleura with walled-off (loculated) fluid. An abdominal scan was normal. An attempt to drain fluid produced none. A pleural biopsy showed epithelioid malignant pleural mesothelioma: the tumor cells stained positive for calretinin and WT-1 and negative for TTF-1. Testing for the BAP1 gene was recommended but not done. The patient developed respiratory failure and died about one week after the diagnosis was confirmed. The authors concluded that this cancer should be considered in young adults with fluid around the lung even without asbestos exposure. They stated that no autopsy was performed.

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), with a brief comparison to a few published reports
• Who was studied: one 23-year-old man from rural Bihar, India, with no prior medical illness
• Exposure: no history of asbestos exposure was reported for the patient; no fiber type or product is involved
• Main results:
  • About 4 months before admission the patient had progressive right-sided chest and lumbar pain, breathlessness, intermittent fever, poor appetite and about 1.5 kg of weight loss
  • Initial evaluation suggested tuberculous pleuritis; the authors linked the diagnostic delay to initial empiric anti-tuberculosis therapy
  • Imaging showed diffuse nodular pleural thickening with loculated (walled-off) fluid
  • CT of the abdomen was normal
  • Biopsy tissue examination and immunohistochemistry confirmed epithelioid malignant pleural mesothelioma (calretinin positive, WT-1 positive, TTF-1 negative)
  • Germline BAP1 genetic testing was recommended but not performed
  • The patient developed hypoxemic respiratory failure and died within 48 hours of the onset of deterioration, approximately 1 week after the diagnosis was confirmed
• The authors' conclusion: The authors concluded that malignant pleural mesothelioma should be considered in young adults with pleural effusion even without asbestos exposure, and that early pleural biopsy with immunohistochemistry is essential, particularly in tuberculosis-endemic settings
• Limitations the authors state:
  • An expanded immunohistochemical panel and germline genetic testing, including BAP1, could not be performed because of resource constraints and the patient's rapid deterioration
  • Pleural fluid biochemical analysis was not available because the aspiration produced no fluid (dry tap)
  • No autopsy was performed to assess the full extent of the disease

Topics

Medical terms in this study, explained in our Lexicon: Pleural Mesothelioma, Asbestos Exposure, Endemic, Pleuritic Chest Pain, Dyspnea, Pleural Thickening, Ultrasound, Pleural Biopsy.

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