Dr Zainab Manan, Dr Junaid Zeb, Dr Shafiq-ur-Rehman, Dr Muhammad Shoaib.
Tuberculosis (TB) is a leading cause of mortality worldwide, with a growing mortality rate. We present a rare case of atypical presentation of pulmonary TB in a 26 years old male patient, who presented to outpatient department with complaints of fever and generalized weakness for last 5days. Fever which was high grade intermittent, more at evening time with no other associated symptoms and treated with Levofloxacin and Moxifloxacin. Patient was vaccinated with BCG at birth. Socioeconomic history was satisfactory. On examination patient had only pleural rub at left lower lung zone with no other significant positive sign. Routine baseline investigations were normal with normal ESR value. However, patient’s X-ray chest showed left sided pleural effusion. Ultrasound guided diagnostic pleural tap was done which showed total proteins of 5g/dl, LDH 1920U/L, glucose 57mg/dl, ADA of 25IU, no AFB seen, along with negative culture and gene expert. ICT-TB showed negative IgG and IgM antibodies. Patient was treated empirically with Anti Tuberculosis drugs(ATT) and 30mg steroids (prednisolone for 20days). Clinically patient responded to ATT with regression of symptoms and after 20days of therapy patient was fully normal on examination as well as x-ray showed no pleural fluid and ATT was then continued for 6months with full recovery of patient. 13 As evidenced by this case in which all serological tests recommended for tuberculosis were normal and patient presented with a short history and then responded very well to the empirical treatment of ATT. Key Words: Tuberculosis, Pulmonary tuberculosis, Pleural Biopsy, Pleural effusion, Acid fast Bacilli.