A Complex Case: Tubercular Pleural Effusion, Infarct, and Multisystem Involvement

Tuberculous pleural effusion, the second most common type of tuberculosis, poses diagnostic and management challenges, especially in patients with multiple comorbidities. A 58-year-old female with a history of poorly controlled diabetes mellitus, hypertension, hypothyroidism, coronary artery disease post-angioplasty, and stable chronic kidney disease presented with fever with chills, reduced appetite, dyspnea, and dysuria. A chest X-ray showed a blunted right costophrenic angle and ultrasonography revealed a moderate pleural effusion on the right side. Pleural fluid analysis confirmed tuberculous pleural effusion. Five days later, she developed slurred speech and a tingling sensation on the left side of her body. A computed tomography scan showed a left non-hemorrhagic lacunar infarct in the frontal lobe, which was confirmed by magnetic resonance imaging. Cerebrospinal fluid was negative for tuberculosis. She was started on antiplatelets for the infarct. Electroencephalography was normal. She had hypocalcemia and hyponatremia related to renal failure, which were also corrected. This case illustrates the challenges of managing tuberculous pleural effusion in patients with multiple comorbidities. Timely diagnosis and a comprehensive multidisciplinary approach are crucial for navigating the complexities of the case.