Tuberculous Pleurisy in a Patient with a History of Breast Cancer: Diagnostic Challenges and Management Options
Abstract
Background: Tuberculosis (TB) and cancer are increasingly prevalent diseases that can be challenging to diagnose due to similarities in clinical and radiological findings. This case report describes a 46-year-old woman with a history of breast cancer who developed tuberculous pleurisy (TP).
Case presentation: A 46-year-old woman who underwent mastectomy and chemotherapy for BC in 2023 had hypertension, but no history of TB. The patient presented with dry cough, fever, and stomach discomfort, with an oxygen saturation level of 60%, but no respiratory distress before their appointment. Microscopy and culture tests were negative for Mycobacterium TB, A positive result was observed with an IFN-γ level of 0.35 IU/ml and 26% of the negative control after TB antigen stimulation. Histological analysis using hematoxylin and eosin staining showed Langhans giant cells, epithelioid cell granulomas, caseous necrosis, and necrotic foci. These findings indicate granulomatous inflammation with no signs of malignancy. Following the diagnosis, the patient received a daily dose of 300 mg isoniazid, 600 mg rifampin, 1500 mg pyrazinamide, and 10 mg pyridoxine for six months without any adverse effects.
Conclusion: Physicians must employ a combination of diagnostic techniques, including morphological and microbiological confirmation, to accurately diagnose pleural effusion in this patient population.
Full text article
References
Bhatt M, Kant S, Bhaskar R. Pulmonary tuberculosis as differential diagnosis of lung cancer. South Asian J Cancer. 2012;1(1):36–42. doi: 10.4103/2278-330X.96507.
Thomas R, Jenkins S, Eastwood PR, Lee YC, Singh B. Physiology of breathlessness associated with pleural effusions. Curr Opin Pulm Med. 2015;21(4):338–45. doi: 10.1097/MCP.0000000000000174.
Zhai K, Lu Y, Shi HZ. Tuberculous pleural effusion. J Thorac Dis. 2016;8(7):E486–94. doi: 10.21037/jtd.2016.05.87.
Shaw JA, Diacon AH, Koegelenberg CFN. Tuberculous pleural effusion. Respirology. 2019;24(10):962–71. doi: 10.1111/resp.13673.
Shaw JA, Irusen EM, Diacon AH, Koegelenberg CF. Pleural tuberculosis: A concise clinical review. Clin Respir J. 2018;12(5):1779–86. doi: 10.1111/crj.12900.
Nayak S, Acharjya B. Mantoux test and its interpretation. Indian Dermatol Online J. 2012;3(1):2–6. doi: 10.4103/2229-5178.93479.
Starke JR. Tuberculosis skin testing: new schools of thought. Pediatrics. 1996;98(1):123–5.
Chaturvedi N, Cockcroft A. Tuberculosis screening in health service employees: who needs chest X-rays? Occup Med (Lond). 1992;42(4):179–82. doi: 10.1093/occmed/42.4.179.
Trajman A, Pai M, Dheda K, van Zyl Smit R, Zwerling AA, Joshi R, et al. Novel tests for diagnosing tuberculous pleural effusion: what works and what does not? Eur Respir J. 2008;31(5):1098–106. doi: 10.1183/09031936.00147507.
Hwang SY, Kim JY, Lee HS, Lee S, Kim D, Kim S, et al. Pulmonary Tuberculosis and Risk of Lung Cancer: A Systematic Review and Meta-Analysis. J Clin Med. 2022;11(3):765. doi: 10.3390/jcm11030765.
Silva DR, Valentini DF Jr, Müller AM, de Almeida CP, Dalcin Pde T. Pulmonary tuberculosis and lung cancer: simultaneous and sequential occurrence. J Bras Pneumol. 2013;39(4):484–9. doi: 10.1590/S1806-37132013000400013.
Farrokh D, Marashi M, Fallah Rastegar Y, Boloursaz Mashhadi S. The Coexistence of Carcinoma and Tuberculosis in One Breast: A Case Report and Literature Review. Int J Cancer Manag. 2017;10(8):e6185. doi: 10.5812/ijcm.6185.
Levi G, Rocchetti C, Mei F, Stella GM, Lettieri S, Lococo F, et al. Diagnostic role of internal mammary lymph node involvement in tuberculous pleurisy: a multicenter study. Pulmonology. 2022:S2531-0437(22)00022-8. doi: 10.1016/j.pulmoe.2022.01.010.
Nanthanangkul S, Promthet S, Suwanrungruang K, Santong C, Vatanasapt P. Incidence of and Risk Factors for Tuberculosis among Cancer Patients in Endemic Area: A Regional Cohort Study. Asian Pac J Cancer Prev. 2020;21(9):2715–21. doi: 10.31557/APJCP.2020.21.9.2715.
Cohen LA, Light RW. Tuberculous Pleural Effusion. Turk Thorac J. 2015;16(1):1–9. doi: 10.5152/ttd.2014.001.
Marel M, Stastny B, Melínová L, Svandová E, Light RW. Diagnosis of pleural effusions. Experience with clinical studies, 1986 to 1990. Chest. 1995;107(6):1598–603. doi: 10.1378/chest.107.6.1598.
Ferrer J, Roldán J, Teixidor J, Pallisa E, Gich I, Morell F. Predictors of pleural malignancy in patients with pleural effusion undergoing thoracoscopy. Chest. 2005;127(3):1017–22. doi: 10.1378/chest.127.3.1017.
Lo Cascio CM, Kaul V, Dhooria S, Agrawal A, Chaddha U. Diagnosis of tuberculous pleural effusions: A review. Respir Med. 2021;188:106607. doi: 10.1016/j.rmed.2021.106607.
ROPER WH, WARING JJ. Primary serofibrinous pleural effusion in military personnel. Am Rev Tuberc. 1955;71(5):616–34. doi: 10.1164/artpd.1955.71.5.616.
Conde MB, Loivos AC, Rezende VM, Soares SL, Mello FC, Reingold AL, et al. Yield of sputum induction in the diagnosis of pleural tuberculosis. Am J Respir Crit Care Med. 2003;167(5):723–5. doi: 10.1164/rccm.2111019.
Porcel JM. Tuberculous pleural effusion. Lung. 2009;187(5):263–70. doi: 10.1007/s00408-009-9165-3.
Arrington CW, Hawkins JA, Richert JH, Hopeman AR. Management of undiagnosed pleural effusions in positive tuberculin reactors. Am Rev Respir Dis. 1966 Apr;93(4):587-93. doi: 10.1164/arrd.1966.93.4.587.
Authors
Copyright (c) 2024 Archives of Breast Cancer
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
Copyright©. This is an open-access article distributed under the terms of the Creative Commons Attribution-Non-Commercial 4.0 International License, which permits copy and redistribution of the material in any medium or format or adapt, remix, transform, and build upon the material for any purpose, except for commercial purposes.