Pleural tuberculosis mimicking malignant mesothelioma

Our plain-English summary of Pleural tuberculosis mimicking malignant mesothelioma, by W. Dawood, D. La Garza Henriette, G. Iliescu, et al (Respiratory Medicine Case Reports, 2020).

The study

• Authors: W. Dawood, D. La Garza Henriette, G. Iliescu, C. Moran, H. Grosu
• Journal: Respiratory Medicine Case Reports
• Published: 2020;29:100964
• Type of article: Case report
• Cited by: 2 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

In plain English

This case report described one 67-year-old man seen at the authors' clinic because mesothelioma was suspected. The article does not mention asbestos exposure. Nine months earlier he had pneumonia with fluid around the right lung, and 1.3 L of fluid was drained. He had no symptoms when seen. A CT scan showed thickened, nodular lining of the right lung, and a PET-CT scan showed a pattern the authors called typical for mesothelioma. A first ultrasound-guided biopsy and later surgical biopsies did not show mesothelioma. The immune-staining pattern favored a reactive, non-cancer process. Lymph node biopsies showed granulomatous inflammation but no tumor. Early tuberculosis and fungus cultures were negative. A few months later, PET scans showed new fluid around the left lung, fluid in the abdomen, and nodules in the abdominal lining. A left-side biopsy showed florid granulomatous inflammation, and final cultures grew Mycobacterium tuberculosis. The patient started four-drug tuberculosis treatment and improved. The authors concluded that active tuberculosis must be considered when diffuse thickening of the lung lining takes up the PET scan tracer (FDG), even without symptoms.

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 67-year-old man seen at the authors' clinic (authors affiliated with The University of Texas MD Anderson Cancer Center, Houston) because mesothelioma was suspected. Nine months earlier he had pneumonia with a right-sided effusion drained of 1.3 L of fluid.
• Exposure: The article does not report any asbestos or other occupational exposure. The condition studied was pleural tuberculosis mimicking mesothelioma.
• Main results:
  • At evaluation the patient had no symptoms.
  • CT showed a small right pleural effusion with thickened, nodular pleura suspicious for mesothelioma. PET-CT showed FDG uptake along the nodular right pleural thickening that the authors described as typical for mesothelioma.
  • The first ultrasound-guided pleural biopsy showed scant atypical cells. Staining suggested they came from histiocytes (immune cells), and a repeat biopsy was recommended.
  • Initial cultures for tuberculosis and fungus were negative.
  • Surgical pleural biopsies by anterior thoracotomy found extremely thick, rock-hard pleura. The immunophenotype favored a reactive process.
  • Lymph node biopsies at mediastinoscopy showed no tumor evidence of mesothelioma, only non-necrotizing granulomatous inflammation.
  • A few months later, PET showed persistent right pleural thickening, a new left pleural effusion, ascites, and FDG-avid peritoneal nodularity.
  • Left pleuroscopy found a lymphocyte-predominant effusion with high protein (6.5 gm/dl) and cholesterol (102 mg/dl). The biopsy showed florid granulomatous inflammation.
  • Final cultures were positive for Mycobacterium tuberculosis.
  • The patient was started on a four-drug regimen (ethambutol, isoniazid, pyrazinamide and rifampin) and showed clinical improvement.
• The authors' conclusion: The authors concluded that active tuberculosis must be considered in the differential diagnosis of diffuse FDG-avid pleural thickening, even when the patient has no symptoms.

Topics

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

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