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TB Pleural Effusion — RACP Adult Medicine MCQ

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ModerateRespiratoryTB Pleural EffusionRACP Adult Medicine

A 30-year-old man from India presents with a 6-week history of fever, night sweats, and weight loss. He has a unilateral pleural effusion. Pleural fluid: protein 55 g/L, LDH 600 U/L, glucose 2.8 mmol/L, lymphocyte-predominant (90%), ADA 85 U/L. AFB smear is negative. What is the most likely diagnosis?

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Correct answer: A — Tuberculous pleural effusion

Lymphocyte-predominant exudative effusion with elevated ADA (>40 U/L) in a young man from a TB-endemic area with constitutional symptoms is highly suggestive of tuberculous pleural effusion. ADA >40 has >90% sensitivity for TB pleuritis. Pleural biopsy increases diagnostic yield. Treatment is standard 6-month anti-TB therapy (2RHZE/4RH).

Reference: eTG Antibiotic – 2025 – Tuberculosis; WHO TB Treatment Guidelines 2022