TUBERCULOSIS PLEURO-PERICARDITIS: SO MUCH FIBRIN! CASE REPORT

A young man with thoracic pain and progressive dyspnea was hospitalized for a pleuro-pericarditis. Ultrasonography confirmed the presence of left pleural and pericardial effusion with a high amount of fibrin. With exudative characters and without macroscopic appearance of empyema, the left pleural effusion has reoccurred two days later during the diagnosis period. Bacteriological exams were repetitively negative. A malign etiology was excluded as no atypical cells in the pleural fluid were found. Adenosine deaminase level was not helpful for the diagnosis. The diagnosis was established through video assisted thoracoscopy pleural biopsy which identified pleural granulomas. This case illustrates the difficulty of a pleuro-pericarditis tuberculosis diagnosis.