The Journal of Pediatric Infectious Diseases and lmmunology Online Journal


The Journal of Pediatric Infectious Diseases and Immunology > Vol.32 No.3 contents > Abstract

Article in Japanese

A 10-year-old boy case suspected of tuberculous pleurisy

Yoshihiro TAURA1,2), Utsuki MATSUMURA3), Masamichi ASAZUMA4), Takashi MORITA1), Hisato ITO1)

Tuberculous pleurisy is a rare disease, but can develop in all children. Although a pleural effusion test is often performed for diagnosis, it is rare to obtain a definitive diagnosis. We report a case of a 10-year-old boy. He was admitted with a 4-day history of fever, cough, chest pain, and dyspnea. On auscultation, he had significantly reduced breath sound in the left lung field, and chest radiography and computed tomography showed a massive pleural effusion in the left side. Initially, we suspected bacterial pleuritis or pleurisy associated with Mycoplasma infection. He was treated with ampicillin/sulbactam 150 mg/kg/day, azithromycin 10 mg/kg/day, or ceftazidime 80 mg/kg/day, without effect. Mycobacterium smear; culture tests of sputum, gastric juice, and pleural effusion; tuberculin reaction test; and interferon gamma release assay(IGRA) were all negative. Although we could not prove the involvement of Mycobacterium tuberculosis, we suspected M. tuberculosis pleurisy from the lymphocyte ratio(96.2%) and adenosine deaminase(ADA) value(92.9U/L) of the pleural effusion and treated this empirically. From the 4 days after admission anti-tuberculosis drugs(rifampicin 450 mg/day, isoniazid 300 mg/day, ethambutol 750 mg/day, pyrazinamide 1100 mg/day) were started, and the clinical symptoms and laboratory findings improved promptly. Tuberculous pleuritis, if not treated, poses a risk of developing into pulmonary tuberculosis. It is therefore important to consider treatment based on clinical symptoms as well as pleural effusion lymphocyte ratio and ADA level.

1) Department of Pediatrics, Kyoto Chubu Medical Center
2) Department of Pediatrics, Kyoto Prefectural University of Medicine
3) Department of Pediatrics, Maizuru Medical Center
4) Department of Pediatrics, Matsushita Memorial Hospital

Key words tuberculosis, unilateral pleural effusion, ADA value of the pleural effusion
Received October 31, 2019
Accepted June 25, 2020

32 (3):234─241,2020