Two Case Reports of Drug-Resistant Tuberculous Pleurisy in Children: Thoracoscopic Pleural Biopsy and PCR-Based Drug-Resistance Testing.
- 1Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu,People's Republic of China.
- 2Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu,People's Republic of China.
Abstract
Background
Drug-resistant tuberculous pleurisy is difficult to diagnose in children because pleural fluid is paucibacillary, culture is slow and frequently negative, and Xpert detects only rifampicin resistance.Case presentation
We report two children in whom thoracoscopic pleural biopsy combined with PCR-high-resolution melting (HRM) drug-resistance testing identified drug-resistant tuberculosis. Case 1, an 8-year-old girl with tuberculous pleurisy, showed persistent pleural thickening and a new mass after two months of standard first-line therapy; pleural tissue PCR detected rpoB and inhA mutations, confirming multidrug-resistant tuberculosis (MDR-TB), and she responded to an all-oralbedaquiline- and delamanid-containing regimen. Case 2, a 9-year-old boy with loculated tuberculous pleurisy and negative cultures, had an rpoB mutation confirming rifampicin-monoresistant tuberculosis; he recovered with a rifampicin-sparing regimen and remained relapse-free at one year.Conclusion
In pediatric tuberculous pleurisy, particularly when fluid-based testing is uninformative or first-line therapy fails, thoracoscopic pleural biopsy combined with molecular drug-resistance testing of tissue is decisive for detecting occult drug-resistant tuberculosis and enabling timely, individualized treatment.
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BibTeX
@article{huang2026case,
title = {{Two Case Reports of Drug-Resistant Tuberculous Pleurisy in Children: Thoracoscopic Pleural Biopsy and PCR-Based Drug-Resistance Testing.}},
author = {Yunlian Huang and Qin Guo and Yiyuan Li and Fangyong Jiang and Ruoxi He and Yu Zhu},
journal = {Infection and drug resistance},
year = {2026},
month = oct,
doi = {10.2147/idr.s653638},
url = {https://europepmc.org/article/MED/42910207},
note = {CC BY-NC},
}
RIS
TY - JOUR
TI - Two Case Reports of Drug-Resistant Tuberculous Pleurisy in Children: Thoracoscopic Pleural Biopsy and PCR-Based Drug-Resistance Testing.
AU - Yunlian Huang
AU - Qin Guo
AU - Yiyuan Li
AU - Fangyong Jiang
AU - Ruoxi He
AU - Yu Zhu
PY - 2026
DA - 2026/10/17
JO - Infection and drug resistance
DO - 10.2147/idr.s653638
UR - https://europepmc.org/article/MED/42910207
AB - Background Drug-resistant tuberculous pleurisy is difficult to diagnose in children because pleural fluid is paucibacillary, culture is slow and frequently negative, and Xpert detects only rifampicin resistance.Case presentation We report two children in whom thoracoscopic pleural biopsy combined with PCR-high-resolution melting (HRM) drug-resistance testing identified drug-resistant tuberculosis. Case 1, an 8-year-old girl with tuberculous pleurisy, showed persistent pleural thickening and a new mass after two months of standard first-line therapy; pleural tissue PCR detected rpoB and inhA mutations, confirming multidrug-resistant tuberculosis (MDR-TB), and she responded to an all-oralbedaquiline- and delamanid-containing regimen. Case 2, a 9-year-old boy with loculated tuberculous pleurisy and negative cultures, had an rpoB mutation confirming rifampicin-monoresistant tuberculosis; he recovered with a rifampicin-sparing regimen and remained relapse-free at one year.Conclusion In pediatric tuberculous pleurisy, particularly when fluid-based testing is uninformative or first-line therapy fails, thoracoscopic pleural biopsy combined with molecular drug-resistance testing of tissue is decisive for detecting occult drug-resistant tuberculosis and enabling timely, individualized treatment.
SN - 1178-6973
ER -