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Peer-reviewedCC BY-NC-NDInternal Medicine

Tuberculous Pleurisy Highlighting the Need to Consider Primary Tuberculosis in Interferon-gamma Release Assay-negative Patients

  • Saki Takeda
  • Tatsuya Nagai
  • Taiki Kawai
  • Masaki Ikeda
  • Koshiro Sakamoto
  • Nami Kuji
  • Sae Kawafune
  • Hiroki Kawakami
  • Soichiro Yamaji
  • Yuki Sato
  • Nao Sato
  • Jun Hayashi
3 more authors
  • Hikaru Ito
  • Hiroyuki Ito
  • Kei Nakashima
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Abstract

We report a case of tuberculous pleurisy in a 54-year-old man who initially presented with negative interferon-gamma release assay (IGRA) results and elevated pleural fluid adenosine deaminase (ADA) levels. Bacteriological confirmation was obtained only when the pleural fluid culture grew Mycobacterium tuberculosis one month later. The IGRA yielded positive results approximately two months after symptom onset. This case highlights the limitations of IGRAs and ADA as definitive diagnostic tools and underscores the need to consider primary tuberculosis in early IGRA negative cases. Clinicians should be aware of the time-dependent nature of immune sensitization when evaluating patients with suspected tuberculous pleurisy.

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Cite

BibTeXRIS
BibTeX
@article{takeda2026tuberculous,
  title = {{Tuberculous Pleurisy Highlighting the Need to Consider Primary Tuberculosis in Interferon-gamma Release Assay-negative Patients}},
  author = {Saki Takeda and Tatsuya Nagai and Taiki Kawai and Masaki Ikeda and Koshiro Sakamoto and Nami Kuji and Sae Kawafune and Hiroki Kawakami and Soichiro Yamaji and Yuki Sato and Nao Sato and Jun Hayashi and Hikaru Ito and Hiroyuki Ito and Kei Nakashima},
  journal = {Internal Medicine},
  year = {2026},
  month = oct,
  doi = {10.2169/internalmedicine.6693-25},
  url = {https://www.jstage.jst.go.jp/article/internalmedicine/65/19/65_6693-25/_article},
  note = {CC BY-NC-ND},
}
RIS
TY  - JOUR
TI  - Tuberculous Pleurisy Highlighting the Need to Consider Primary Tuberculosis in Interferon-gamma Release Assay-negative Patients
AU  - Saki Takeda
AU  - Tatsuya Nagai
AU  - Taiki Kawai
AU  - Masaki Ikeda
AU  - Koshiro Sakamoto
AU  - Nami Kuji
AU  - Sae Kawafune
AU  - Hiroki Kawakami
AU  - Soichiro Yamaji
AU  - Yuki Sato
AU  - Nao Sato
AU  - Jun Hayashi
AU  - Hikaru Ito
AU  - Hiroyuki Ito
AU  - Kei Nakashima
PY  - 2026
DA  - 2026/10/01
JO  - Internal Medicine
DO  - 10.2169/internalmedicine.6693-25
UR  - https://www.jstage.jst.go.jp/article/internalmedicine/65/19/65_6693-25/_article
AB  - We report a case of tuberculous pleurisy in a 54-year-old man who initially presented with negative interferon-gamma release assay (IGRA) results and elevated pleural fluid adenosine deaminase (ADA) levels. Bacteriological confirmation was obtained only when the pleural fluid culture grew Mycobacterium tuberculosis one month later. The IGRA yielded positive results approximately two months after symptom onset. This case highlights the limitations of IGRAs and ADA as definitive diagnostic tools and underscores the need to consider primary tuberculosis in early IGRA negative cases. Clinicians should be aware of the time-dependent nature of immune sensitization when evaluating patients with suspected tuberculous pleurisy.
SN  - 1349-7235
SN  - 0918-2918
ER  -