A 70-year-old female patient presented with exudative, lymphocytic left-sided pleural effusion. Blind pleural biopsy histology revealed granuloma without caseous necrosis. Oral corticosteroid therapy was well tolerated and proved effective following one month of treatment.

Differentiating tuberculosis (TB) from sarcoidosis, especially in TB endemic regions, is one of the major clinical challenges because these two diseases may show considerable similarity in terms of clinical manifestations, imaging findings, and granulomatous pattern. In addition, the presence of noncaseating granuloma alone is not sufficient for the definitive diagnosis of sarcoidosis because in some cases, TB may also show granulomas without necrosis. In this report, a 83-year-old man is presented with fever, productive cough, chest pain, weakness, and mild dyspnea, who had a history of pleural and pericardial effusion, with elevated pericardial adenosine deaminase (ADA), a positive tuberculin skin test, and pleural granuloma. The patient was initially treated with anti-TB therapy for probable diagnosis of TB pleurisy and also corticosteroid for probable sarcoidosis, but because of the development of drug-induced hepatitis, treatment was interrupted and modified several times. On subsequent presentation, chest high-resolution computed tomography (HRCT) showed pericardial thickening, pericardial effusion, pulmonary nodules with a perilymphatic distribution, right hilar lymphadenopathy, and a cavitary lesion in the right upper lobe. Sputum smear was 3+ positive for acid-fast bacilli, and anti-TB treatment was reinitiated. Nevertheless, because of the imaging pattern, relative response to corticosteroid, and pathologic findings including non-necrotizing granulomas, the possibility of concurrent sarcoidosis was also raised. After evaluating the possibility of TB progression and the effect of interruptions in anti-TB therapy caused by drug-induced hepatitis, the patient was treated with anti-TB regimen together with prednisolone and later azathioprine. Hence, the clinical case of pulmonary TB and probable sarcoidosis has been described in this study. The patient underwent anti-TB and immunosuppression therapy and experienced significant improvement.

Pediatric Pott disease can require debridement, corpectomy, and anterior column reconstruction when vertebral destruction, instability, deformity, or neurologic risk is present. Years later, postoperative structural sequelae may overlap clinically and radiologically with suspected recurrent thoracic tuberculosis. We report the case of a six-year-old girl with thoracic vertebral tuberculosis diagnosed in 2021, supported by immunologic, molecular, and histopathologic evidence, including vertebral granulomatous inflammation with acid-fast bacilli. She underwent right posterolateral thoracotomy, thoracic corpectomy centered at T4, and reconstruction with an approximately 2-cm fibular structural allograft, followed by completion of antituberculous therapy. In 2025, she presented with fever, persistent cough, recurrent respiratory episodes, weight loss, severe malnutrition, calcified mediastinal findings, extrinsic airway compression, and intrathoracic bone-density material adjacent to the prior reconstruction, raising concern for pulmonary reinfection or pleural tuberculosis. GeneXpert, acid-fast bacilli smears, cultures, and mycobacterial polymerase chain reaction testing were negative or non-confirmatory, and no safe percutaneous biopsy window was documented. Diagnostic right posterolateral thoracotomy demonstrated pleuropulmonary adhesions and material compatible with a migrated fibular allograft, without abnormal thoracic or hilar lymph nodes. Right pleural histopathology showed fibrosing pleuritis without granulomas, caseous necrosis, active inflammation, acid-fast bacilli, or malignancy. Empirical antituberculous retreatment was not restarted. This case, accompanied by a focused critical diagnostic review, emphasizes multimodal correlation to differentiate active tuberculous relapse from postoperative structural mimics.

Paragonimiasis, a foodborne parasitic disease caused by Paragonimus, typically presents with pleural effusion and is often misdiagnosed as tuberculous pleurisy, especially in endemic regions. The present study aimed to investigate the causes of misdiagnosis of pleural effusion (PE) caused by paragonimiasis as tuberculous pleurisy and to propose preventive strategies. The clinical diagnostic and treatment course of one patient with paragonimiasis misdiagnosed as tuberculous PE (TPE) was analyzed. A literature review of English-language case reports and series on paragonimiasis with PE misdiagnosed as TPE was performed using PubMed, Google Scholar, and Web of Science databases up to January 1, 2026. A 41-year-old male patient presented to Gucheng County People's Hospital (Shiyan, China) in October 2024 with a 10-day history of cough, sputum production, fever and shortness of breath. with cough, sputum, fever and dyspnea. Chest computed tomography (CT) showed left-sided PE. Tuberculosis antibody detection was positive and erythrocyte sedimentation rate was elevated. The patient was misdiagnosed with TPE and showed poor response to antituberculosis treatment. At 8 months later, readmission revealed markedly elevated eosinophils in peripheral blood (18%; normal range: 0.4-8.0%, absolute count, 2.61x10[9]/l; normal range: 0.02-0.5x10[9]/l), pleural fluid and pleural biopsy tissue. The patient had longterm occupational exposure to freshwater aquatic products without a history of raw seafood ingestion. Intradermal test for Paragonimus-specific antigen (IDTPA) and serum Paragonimus IgG antibody were both positive. Following four courses of praziquantel (25 mg/kg three times daily; 3 days/course), the patient achieved clinical cure with resolution of PE and normalization of eosinophil count (0.46x10[9]/l). The correct diagnosis of paragonimiasis was established by peripheral and pleural eosinophilia, positive IDTPA and serology and response to praziquantel. A literature review of 16 English language publications (51 cases) showed that 92.2% of patients had a history of raw or undercooked freshwater product ingestion, 94.1% had peripheral blood eosinophilia and 93.8% were seropositive by ELISA. By contrast, the present case involved long-term occupational exposure to freshwater aquatic products without raw seafood ingestion, an unusual but important route of infection. All reported patients responded to praziquantel. Elevated eosinophil levels in peripheral blood and pleural fluid and biopsy tissue are valuable clues for the diagnosis of paragonimiasis. Detailed inquiry into occupational and environmental exposure in addition to dietary history is essential. IDTPA and/or serum Paragonimus IgG antibody testing enables early diagnosis. Praziquantel remains the standard effective treatment.

Data on the clinical characteristics and outcomes of patients with pleural infection are limited. This retrospective study aimed to describe the clinical characteristics and outcomes associated with community-acquired pleural infection (CAPI) and hospital-acquired pleural infection (HAPI) in a large Chinese tertiary-care hospital in Beijing over 11 years. The study included 832 patients, of whom 84.9% had HAPI. The most common cause of CAPI was pneumonia and pleurisy, whereas the most common cause of HAPI was trauma or chest surgery. The predisposing factors with statistically significant differences between HAPI and CAPI included the presence of an abdominal indwelling catheter (P = 0.012), thoracic cavity drainage (⩾ 10 days) (P = 0.003), and use of broad-spectrum antibiotics (P = 0.002). Staphylococcus epidermidis (24.76%) and Streptococcus species (27.00%) were the most common Gram-positive bacteria in HAPI and CAPI, respectively, whereas Acinetobacter baumannii (8.61%) and Escherichia coli (4.38%) were the most common Gram-negative pathogens in HAPI and CAPI, respectively. Virtually any Gram-positive bacteria were resistant to linezolid and vancomycin, except Enterococcus faecium displaying resistance to vancomycin (9.88%). The 30-day mortality after the onset of pleural infection was 13.1%. Multivariable logistic regression analysis suggested that intensive care unit (ICU) admission, solid tumors, chronic renal failure, and a decreased serum albumin level were independent risk factors for pleural infection. No statistically significant difference in mortality was observed between patients with CAPI (11.9%) and those with HAPI (13.3%). Differences were noted in clinical characteristics between HAPI and CAPI. The findings might guide empirical treatments and help improve infection control strategies.

A 25-year-old previously healthy man presented with a productive cough for 2 months and progressive dyspnea for 1 week. He did not respond to initial anti-infective treatment at a local hospital. Chest computed tomography (CT) demonstrated diffuse miliary nodules, ground-glass opacities throughout both lungs, and bilateral pleural effusion (more prominent on the right). Laboratory tests revealed type I respiratory failure, elevated inflammatory markers, hyponatremia, hypoproteinemia, and raised tumor markers (NSE, CYFRA21-1, SCC, CA125). Sputum acid-fast bacilli smears were negative, but pleural fluid analysis showed elevated adenosine deaminase and interferon-gamma, suggestive of tuberculous pleurisy. Percutaneous lung biopsy confirmed epithelioid granulomas with positive acid-fast staining, establishing the diagnosis of miliary tuberculosis, tuberculous pleurisy, severe pulmonary infection, and acute respiratory distress syndrome (ARDS). Anti-tuberculosis therapy was withheld initially due to elevated liver enzymes and was initiated once liver function normalized. High-dose methylprednisolone (160 mg/day) combined with noninvasive positive pressure ventilation (NIPPV) was added, yielding initial improvement. However, complications arose after 8 days of NIPPV, including pneumothorax, subcutaneous and mediastinal emphysema, and suspected disseminated intravascular coagulation (DIC). NIPPV was discontinued, subcutaneous incision and xiphoid puncture drainage performed, and supportive measures (cryoprecipitate, immunoglobulin, continued glucocorticoids) instituted. Symptoms and imaging gradually resolved. After 1 year of anti-tuberculosis treatment, the patient achieved complete clinical and radiological recovery. This case highlights that, alongside potent anti-tuberculosis therapy, high-dose glucocorticoids combined with NIPPV (with cautious management of barotrauma risks) can effectively control life-threatening miliary tuberculosis complicated by ARDS.

Hepatic hemangioma may be detected in patients with systemic lupus erythematosus (SLE). This study aimed to determine the frequency, radiological characteristics, and potential associated factors of hepatic hemangioma in SLE patients undergoing abdominal imaging. We retrospectively evaluated 221 of 402 SLE patients followed at a tertiary university hospital who underwent abdominal imaging for clinical indications. Demographic, clinical, laboratory, and radiological data were collected from medical records. Factors associated with hepatic hemangioma were analyzed. A total of 221 SLE patients who underwent abdominal imaging were included. All patients underwent abdominal ultrasound as the primary imaging modality. The mean age was 49.62 ± 13.75 years, 86.4% were female, mean age at SLE diagnosis was 36.29 ± 14.48 years, and mean disease duration was 12.81 ± 8.14 years. The most common indication for abdominal imaging was asymptomatic/routine screening/pre-renal biopsy evaluation (n = 117, 53%). Hepatic hemangioma was detected in 11.8% (n = 26) of the imaged SLE patients. Among these, 69.2% were identified after SLE diagnosis, 27% concurrently, and 3.8% before diagnosis. Most hemangiomas were solitary (65.4%), with a mean diameter of 2.57 ± 2.22 cm. Patients with hepatic hemangioma had significantly longer disease duration (15.85 ± 7.82 vs. 12.40 ± 8.12 years; p = 0.043) and follow-up duration (15.38 ± 7.98 vs. 11.61 ± 7.89 years; p = 0.030) compared to those without. At SLE diagnosis, pleuritis (19.2% vs. 5.6%; p = 0.035), autoimmune hemolytic anemia (AIHA) (38.5% vs. 18.6%; p = 0.037), and C3 hypocomplementemia (80.8% vs. 55.4%; p = 0.014) were significantly more common in the hemangioma group. Multivariate logistic regression analysis revealed that longer SLE disease duration (OR 1.06 per year; 95% CI 1.01-1.12; p = 0.020) and presence of AIHA at diagnosis (OR 3.42; 95% CI 1.32-8.88; p = 0.011) were independently associated with hepatic hemangioma. Hepatic hemangiomas may be incidentally detected in SLE patients undergoing abdominal imaging. They were significantly more frequent in patients with longer disease duration and in those with AIHA at SLE diagnosis. However, these findings should be interpreted cautiously due to the retrospective design and selected nature of the study population. Prospective longitudinal studies with unselected SLE cohorts and appropriate control groups are needed to better define the true frequency and their associated factors of hepatic hemangiomas in SLE.

Actinobacillus pleuropneumoniae (APP) is the bacterial agent associated with porcine pleuropneumonia, a severe respiratory disease with significant economic impact due to increased mortality and elevated therapeutic costs, whose progression may be exacerbated by environmental factors. This study evaluates the impact of climatic factors, particularly temperature and relative humidity, on mortality in finishing pigs during the fattening phase within a herd with endemic porcine pleuropneumonia. Data were collected from a commercial swine farm between January 2021 and December 2024, including records of local climatic conditions (daily average temperature and relative humidity) and pig mortality rates. Statistical analysis revealed a positive correlation between periods of elevated temperature or humidity and increased mortality associated with respiratory diseases, suggesting that climatic stress contributes to higher mortality in this herd with endemic APP.

A 49-year-old male presented with acute dyspnea and hydropneumothorax. Imaging and biopsy confirmed pleural tuberculosis. Despite atypical features and no risk factors, anti-tuberculosis therapy led to rapid improvement. This case highlights the diagnostic challenge of distinguishing tuberculosis-related hydropneumothorax from necrotizing bacterial pneumonia and empyema in the presence of complex radiological findings.