Vol.23 No.5

Case Report

Tuberculous pleurisy diagnosed by medical thoracoscopy in an adalimumab-treated rheumatoid arthritis patient after treatment of latent tuberculosis infection

Authors

Yasuo Nagafuchi1 , Hirofumi Shoda 1 , Keishi Fujio1 , Satoru Ishii2 , Haruhito Sugiyama2 , Kazuhiko Yamamoto1

  • Department of Allergy and Rheumatology, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongou, Bunkyo-ku, Tokyo 113-8655, Japan
  • Department of Respiratory Medicine, National Center for Global Health and Medicine, Tokyo, Japan
Received:

30 May 2012

Accepted:

3 July 2012

Published online:

1 August 2012

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Abstract

A 28-year-old rheumatoid arthritis woman
treated with adalimumab was admitted with fever, cough,
and right chest pain. X-ray showed right pleural effusion.
By medical thoracoscopy, diffuse white nodules were
observed, and biopsy specimen demonstrated epithelioid
cell granulomas with necrosis and auramine-stained
organisms, which suggested a diagnosis of tuberculous
pleurisy. Medical thoracoscopy can be a potent diagnostic
method when tuberculous pleurisy is suspected. Notably,
despite latent tuberculosis treatment, active tuberculosis
was not prevented.

Key words

Adalimumab, Latent tuberculosis, Pleural tuberculosis, Rheumatoid arthritis, Thoracoscopy