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Open Access Case report

Asymptomatic primary tuberculous pleurisy with intense 18-fluorodeoxyglucose uptake mimicking malignant mesothelioma

Tsutomu Shinohara1*, Naoki Shiota2, Motohiko Kume3, Norihiko Hamada4, Keishi Naruse5 and Fumitaka Ogushi6

Author Affiliations

1 Department of Clinical Investigation, National Hospital Organization National Kochi Hospital, 1-2-25 Asakuranishimachi, Kochi, 780-8077, Japan

2 Department of Hematology and Respiratory Medicine, Kochi Medical School, Kochi University, Nankoku, Kochi, 783-8505, Japan

3 Department of Surgery II, Kochi Medical School, Kochi University, Nankoku, Kochi, 783-8505, Japan

4 Department of Radiology, Kochi Medical School, Kochi University, Nankoku, Kochi, 783-8505, Japan

5 Department of Pathology, Kochi National Hospital Organization National Kochi Hospital, 1-2-25 Asakuranishimachi, Kochi, 780-8077, Japan

6 Division of Pulmonary Medicine, National Hospital Organization National Kochi Hospital, 1-2-25 Asakuranishimachi, Kochi, 780-8077, Japan

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BMC Infectious Diseases 2013, 13:12  doi:10.1186/1471-2334-13-12

Published: 14 January 2013

Abstract

Background

The pathogenesis of primary tuberculous pleurisy is a delayed-type hypersensitivity immunogenic reaction to a few mycobacterial antigens entering the pleural space rather than direct tissue destruction by mycobacterial proliferation. Although it has been shown that pulmonary tuberculosis induces 18-fluorodeoxyglucose (FDG) uptake in active lesions, little is known about the application of FDG positron emission/computed tomography (FDG PET/CT) to the management of primary tuberculous pleurisy.

Case presentation

We report a case of asymptomatic primary tuberculous pleurisy presenting with diffuse nodular pleural thickening without distinct pleural effusion and parenchymal lung lesions mimicking malignant mesothelioma. An initial FDG PET/CT scan demonstrated multiple lesions of intense FDG uptake in the right pleura and thoracoscopic biopsy of pleural tissue revealed caseous granulomatous inflammation. The patient received antituberculous therapy for 6 months, with clearly decreased positive signals on a repeated FDG PET/CT scan.

Conclusion

FDG PET/CT imaging may be useful for evaluating disease activity in tuberculous pleurisy patients with an unknown time of onset.

Keywords:
Primary tuberculous pleurisy; Fluorodeoxyglucose; Positron emission tomography