Hara M, Yashiro T, Yashiro Y. Delayed diagnosis of pulmonary tuberculosis with pleuritis due to ampicillin/sulbactam: A case report. World J Clin Cases 2025; 13(19): 104083 [DOI: 10.12998/wjcc.v13.i19.104083]
Corresponding Author of This Article
Munechika Hara, Department of Internal Medicine, Fujimi-Kogen Hospital, Fujimi-Kogen Medical Center, 11100 Ochiai, Fujimi, Suwa-Gun, Nagano 399-0214, Japan. hara.mnck@fujimihp.com
Research Domain of This Article
Respiratory System
Article-Type of This Article
Case Report
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Munechika Hara, Toshitsugu Yashiro, Yasuaki Yashiro, Department of Internal Medicine, Fujimi-Kogen Hospital, Fujimi-Kogen Medical Center, Nagano 399-0214, Japan
Author contributions: Hara M contributed to conceptualization, data curation, investigation, methodology, resources, supervision, writing–original draft, and writing–review and editing; Yashiro T, Yashiro Y contributed to investigation and writing–review and editing.
Informed consent statement: Informed written consent was obtained from the patient for publication of this report.
Conflict-of-interest statement: The authors declare that they have no conflict of interest disclose.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Munechika Hara, Department of Internal Medicine, Fujimi-Kogen Hospital, Fujimi-Kogen Medical Center, 11100 Ochiai, Fujimi, Suwa-Gun, Nagano 399-0214, Japan. hara.mnck@fujimihp.com
Received: December 12, 2024 Revised: February 6, 2025 Accepted: February 24, 2025 Published online: July 6, 2025 Processing time: 100 Days and 0.4 Hours
Abstract
BACKGROUND
Tuberculosis (TB) remains a global health concern despite decreasing incidence. Delayed TB diagnosis can exacerbate patient outcomes and lead to broader public health issues such as mass infections. Differentiation between TB and bacterial pneumonia is often complicated by variable clinical and radiological manifestations of TB, leading to diagnostic delays.
CASE SUMMARY
An 89-year-old, Japanese male patient with a history of diabetes mellitus, hypertension, and hypothyroidism presented with right-sided chest pain. Based on the elevated inflammatory response, right pleural effusion, and infiltrating shadow in the lung field, the diagnosis of right pleurisy was made and the antibiotic, ampicillin/sulbactam, was administered. The patient’s condition, inflammatory reaction, and right pleural effusion temporarily improved. However, persistent low-grade fever and malaise prompted further evaluation, revealing repeated right pleural effusion and inflammatory response. A right thoracentesis was performed; the patient was diagnosed with tuberculous pleurisy as a result of exudative effusion with lymphocyte predominance, elevated adenosine deaminase levels, and positive Mycobacterium TB polymerase chain reaction test. Anti-TB treatment, including isoniazid, rifampicin, and ethambutol was initiated, leading to significant clinical improvement. The patient successfully completed a 12-month course of TB therapy without recurrence or deterioration.
CONCLUSION
There are cases of TB wherein temporary improvement apparently could be shown through treatment with antimicrobial agents other than anti-TB drugs, necessitating careful evaluation in atypical cases of bacterial pneumonia.
Core Tip: There are cases of tuberculosis (TB) wherein diagnosis is delayed because they appear to improve temporarily after using an antimicrobial other than fluoroquinolone. In cases of pneumonia that follow an atypical course, such as one that improves after treatment with antibacterial drugs but then worsens again, reevaluating the possibility of TB is extremely important.
