Tuberculosis masking T-cell lymphoblastic leukemia

T-cell lymphoblastic leukemia characterized by infiltration of immature T cells mainly in the mediastinum and other lymphoid organs (1). Here we present a case of a forty-five years old female who was presented with tuberculosis pleural effusion but did not respond to treatment and later found to have a T-Cell ALL. Forty-five years old female presented with fever for three weeks with left sided pleural effusion. She was diagnosed to have tuberculous pleural effusion based on positive Mantoux test (12mm induration), lymphocytic exudative pleural effusion and High ADA (80U/L). She was started on anti-tuberculosis treatment but did not respond so she underwent CECT chest and abdomen which showed pleural and pericardial effusion with mediastinal lymphadenopathy. She was further evaluated with a blood picture and bone marrow biopsy which revealed T-cell lymphoblastic leukemia. Tuberculosis can mask the underlying malignancies. In tuberculous pleural effusion if not responded to initial management CT Chest and thoracoscopy with pleural biopsy will help us to diagnose underlying malignancies.