Differential Diagnosis of Pleural Effusion in a Young Adult:Parapneumonic Effusion or Tuberculous Pleurosiy?
3.Uluslararası Sağlık Hİzmetleri Kongresi, Mersin, Turkey, 3 - 04 February 2026, pp.234-235, (Summary Text)
- Publication Type: Conference Paper / Summary Text
- City: Mersin
- Country: Turkey
- Page Numbers: pp.234-235
- Yozgat Bozok University Affiliated: Yes
Abstract
Differential Diagnosis of Pleural Effusion in a Young Adult: Parapneumonic Effusion or Tuberculous Pleurisy?
Pleural effusion is a pathological condition resulting from increased fluid production or decreased absorption between the visceral and parietal pleura. In young adults, parapneumonic effusions are the most common etiology; however, tuberculous pleurisy should always be considered in the differential diagnosis, particularly in tuberculosis-endemic regions. We present a case of parapneumonic effusion with an atypical chronic course initially suggestive of tuberculosis. A 36-year-old male farmer with no known comorbidities presented with a fourmonth history of abdominal pain, fever, and cough, accompanied by a 7-kg weight loss in the last month. He had not responded to prior amoxicillin–clavulanate therapy. Physical examination revealed dullness to percussion and crackles in the middle and lower zones of the right lung. Thoracic computed tomography showed a massive right-sided pleural effusion reaching a depth of 9 cm with secondary compressive atelectasis. Laboratory findings demonstrated elevated C-reactive protein (123.9 mg/L) and erythrocyte sedimentation rate (93 mm/h), while procalcitonin levels were low (0.054 ng/mL). With an initial suspicion of tuberculosis, sputum samples were obtained for acid-fast bacilli smear and culture, and empirical ampicillin–sulbactam therapy was initiated. Sputum culture subsequently revealed Enterobacter aerogenes, prompting a change in antimicrobial therapy to ceftriaxone. Acid-fast bacilli smears were negative. Systemic corticosteroid therapy was added to improve clinical control and reduce the risk of pleural fibrosis. By the 10th day of treatment, inflammatory markers markedly decreased(CRP: 4.5 mg/L, Sediment: 22 mm/h), and radiological evaluation showed regression of the pleural effusion to 2 cm. The patient was discharged in good clinical condition with outpatient follow-up planned. This case emphasizes that bacterial pathogens may cause atypical, chronic pleural effusions in young patients and highlights the importance of a multidisciplinary approach in diagnosis and management.
Keywords: Parapneumonic effusion, Tuberculous pleurisy, Pleural effusion, Young adult