Diagnosis and Management of Tuberculous Pleural Effusion in a Patient With Chronic Obstructive Pulmonary Disease: A Case Report

TL;DR

A 63-year-old man with COPD and a smoking history was diagnosed with tuberculous pleural effusion and successfully treated with a multidisciplinary approach.

Contribution

This case report highlights the importance of early tuberculosis detection in COPD patients through integrated clinical, radiographic, and lab assessments.

Findings

The patient showed clinical improvement after treatment with antitubercular drugs, antibiotics, and pleural drainage.

Combining clinical, radiographic, and laboratory data was critical for diagnosing tuberculous pleural effusion.

A multidisciplinary approach is essential for managing complex cases involving COPD and tuberculosis.

Abstract

A 63-year-old man had been smoking bidis for 25 years and developed tubercular empyema, further complicated by pneumothorax and other pulmonary issues. Over a period of three weeks, the individual experienced a gradual onset of symptoms, including progressive shortness of breath, cough, fever, and chest pain. Radiographic examinations revealed significant left-sided pleural effusion with consolidation and evidence of pneumothorax. Other findings included anemia, hyponatremia, substantially increased lactate dehydrogenase, and adenosine deaminase (ADA), consistent with tubercular or chronic infection. The comprehensive treatment plan involved the administration of antibiotics, antitubercular drugs, draining of the pleural fluid, nebulized bronchodilators, corticosteroids, and broad-spectrum antibiotics. The patient exhibited a positive response, showing notable clinical improvement, which was closely monitored through sequential chest X-rays and ECGs. This would continue to highlight the vital need for early tuberculosis detection in patients with chronic obstructive pulmonary disease due to clinical overlap with other diseases. To diagnose and follow up on tuberculous pleural effusion cases, it was critical to integrate both clinical and radiographic findings with laboratory data. It emphasizes the necessity for a multidisciplinary approach to improve overall treatment outcomes.

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