Case Reports

Adenosine Deaminase Negative Pleural Tuberculosis: A Clinical Case

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Filipa Pereira
Leena Mira
Susana Branco
Helena Victorino
Sofia Marques Santos
Adenosine deaminase; Tuberculosis; Pleural effusion


Tuberculous pleural effusion (TPE) is one of the most common forms of extrapulmonary tuberculosis.

Diagnostic approach of TPE remains the detection of Mycobacterium tuberculosis in pleural fluid (PF), or pleural biopsy specimens, by microscopy or culture, or histological demonstration of caseating granulomas in the pleura along with acid-fast bacilli (AFB). Adenosine deaminase (ADA) in PF has been documented to be useful in the diagnosis of TPE, related to its notable negative predictive value.

We present the case of an 81-year-old patient, with clinical signs of fatigue, weight loss and dry cough, whose imaging studies revealed an extensive left pleural effusion. Despite several positive markers for TPE, ADA was negative. Nevertheless, he underwent tuberculostatic therapy with a favorable response.

Due to variability of pleural fluid ADA measurements in PF, namely race of studied population, age, immune status of the patients, among other factors that may affect the ADA levels, this case aims to alert the influence of clinical context in ADA and the necessity of regional studies for determination of specific regional values.

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