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(Chest. 1997;112:393-397.)
© 1997 American College of Chest Physicians

Tuberculous Pleurisy Is More Common in AIDS Than in Non-AIDS Patients With Tuberculosis

Michael D. Frye MD, FCCP1; Carol J. Pozsik RN2; and Steven A. Sahn MD, FCCP1

1 From the Division of Pulmonary and Critical Care Medicine, Department of Medicine, Medical University of South Carolina, Charleston
2 From the South Carolina Department of Health and Environmental Control, Columbia, SC.

Objective: To investigate the incidence, clinical features, and treatment of tuberculous pleurisy in AIDS patients.

Methods: We reviewed all cases of pleural tuberculosis in AIDS patients in South Carolina from 1988 through 1994. Clinical findings, test results, treatment, and outcome were analyzed.

Main results: Twenty-two (11%) of the 202 AIDS patients with tuberculosis had pleural involvement compared to 6% (169/2,817) pleural involvement in non-AIDS patients (p=0.01). Associated features of AIDS tuberculous pleurisy included substantial weight loss (7.65±1.35 kg) and lower lobe infiltrates (12/22; 55%). No difference in pleural fluid characteristics was found when comparing AIDS patients with a serum CD4 count ge200/µL to patients with CD4 count <200/µL. Two (9%) of the 22 patients died of tuberculosis. Chest radiograph follow-up of 20 patients showed complete resolution in 7, improvement in 10, and no improvement in 3.

Conclusions: In South Carolina, pleural involvement is more common in AIDS patients than in non-AIDS patients with tuberculosis. Tuberculous pleurisy has several atypical features in AIDS patients such as substantial weight loss and lower lobe infiltrates. The outcome of treatment is good for most patients.

Key Words: AIDS • pleurisy • tuberculosis

Submitted on September 3, 1996
Accepted on February 13, 1997




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