A70-22 A Rare Case of Tuberculous Pleurisy Due to Silica Exposure

Abstract Tuberculous pleurisy, the second most common form of extrapulmonary tuberculosis (TB) (after lymphadenitis), shares many epidemiologic features with pulmonary TB. It represents a clinical spectrum that can be self-limited or progressed to empyema, with concomitant pulmonary involvement reported in up to 85% of cases. It is thought to result primarily from a delayed hypersensitivity reaction to M. tuberculosis bacilli (MTb) within the pleural space. Given the paucibacillary nature of the disease, diagnosis relies heavily on pretest probability, including factors such as local TB prevalence, prior exposure, and degree of immunosuppression. The gold standard for definitive diagnosis is the detection of MTb in pleural fluid or tissue, or the presence of caseating granulomas on pleural biopsy-ideally with demonstrable acid-fast bacilli (AFB). We present a case of isolated TB pleurisy secondary to silica exposure. A 30-year-old female, nine weeks pregnant and formerly employed as a glass cutter, presented with one week of dyspnea, pleuritic chest pain, night sweats, and weight loss. Chest X-ray showed left upper lobe opacities, similar to findings noted six years earlier, and a moderate left pleural effusion, initially managed as community-acquired pneumonia with empiric antibiotics. Due to symptom progression, she presented to the emergency department, where chest Computed Tomography (CT) revealed a loculated left pleural effusion, bilateral upper lobe opacities, and scattered tree-in-bud infiltrates. A chest tube was placed, and pleural fluid analysis demonstrated lymphocytic predominance with elevated adenosine deaminase. QuantiFERON-TB testing was positive and bronchoscopy with bronchoalveolar lavage (BAL) revealed acid-fast bacilli on smear and culture. MTb was subsequently confirmed by polymerase chain reaction (PCR). She was diagnosed with active pleural tuberculosis and treated with isoniazid and rifampin for 9 months. While silicosis is a well-recognized risk factor for pulmonary tuberculosis, isolated tuberculous pleurisy in the setting of silica exposure is rarely reported. In this case, the absence of traditional TB exposures yet presence of silica exposure from glass cutting (supported by chronic upper lobe scarring) likely contributed to disease susceptibility.Treatment was completed with a prolonged nine-month regimen given the patient’s pregnancy and increased risk of progression to pulmonary disease. This abstract is funded by: None