Thoracoscopic diagnosis of tuberculous pleuritis mimicking pleural malignancy with chest wall involvement: a challenging case report.

BACKGROUND

Tuberculous pleuritis is a common form of extrapulmonary tuberculosis that may closely mimic pleural malignancy, particularly when associated with loculated effusion, pleural thickening, or chest wall involvement. This diagnostic challenge is amplified in resource-limited settings.

CASE PRESENTATION: We report a 41-year-old male with a 30 pack-year smoking history who presented with a two-month history of pleuritic chest pain, dyspnea, night sweats, and significant weight loss. Imaging revealed a large loculated right-sided pleural effusion with diffuse pleural thickening and associated rib destruction, raising strong suspicion for pleural malignancy. Thoracentesis demonstrated a lymphocyte-predominant exudative effusion. Due to limited diagnostic resources, advanced microbiological investigations were unavailable. The patient underwent video-assisted thoracoscopic surgery (VATS), which revealed diffusely thickened pleura with multiple whitish plaques. Histopathological examination revealed caseating granulomatous inflammation consistent with tuberculous pleuritis. The patient responded well to anti-tuberculous therapy.

CONCLUSIONS

Tuberculous pleuritis can mimic pleural malignancy, particularly in the presence of chest wall involvement. Thoracoscopic pleural biopsy remains a highly valuable diagnostic tool in cases where non-invasive investigations are inconclusive or unavailable.