Uncommon Presentation of Tuberculosis as an Incidentally Discovered Solitary Pleural Tuberculoma

• Published in: The American journal of tropical medicine and hygiene 2021-10, Vol.106 (2), p.376-377
• Main Authors: Kinjo, Takeshi, Shimoji, Mitsuyoshi, Fujita, Jiro
• Format: Article
• Language: English
• Subjects: Humans; Images in Clinical Tropical Medicine; Incidental Findings; Lung Neoplasms - surgery; Male; Middle Aged; Thoracoscopy; Tomography, X-Ray Computed; Tuberculoma - diagnosis; Tuberculoma - diagnostic imaging; Tuberculoma - therapy; Tuberculosis; Tuberculosis, Pleural - diagnosis; Tuberculosis, Pleural - diagnostic imaging; Tuberculosis, Pleural - therapy
• ISSN: 0002-9637; 1476-1645
• DOI: 10.4269/ajtmh.21-0740

A 54-year-old Japanese man with unremarkable social and medical history presented with an abnormal shadow on his chest X-ray during an annual company health checkup. He had the bacille Calmette-Guérin vaccination as a child and had no smoking/foreign travel history. He was asymptomatic, with normal vital signs. He had a white blood cell count of 6,610 cells/µL and a C-reactive protein level of 0.11 mg/dL. Chest X-ray revealed a mass with an incomplete border sign in the right lower lung field. Contrast-enhanced chest computed tomography revealed an encapsulated and peripherally enhancing low-attenuation mass adjacent to the posterolateral chest wall that exhibited an extra-pleural sign. No pleural effusion was observed. Because a chest wall tumor was suspected, video-assisted thoracoscopic surgery for tumor resection was performed. During the surgery, the mass discharged white viscous pus; a specimen was collected, which later tested positive for Mycobacterium tuberculosis complex using a real-time polymerase chain reaction assay targeting 16S recombinant RNA.