Elevated Adenosine Deaminase in Pleural Effusion A Case of Non-Hodgkin Lymphoma Misdiagnosis.
Adenosine deaminase
lymphoma
pleural effusion
tuberculosis
Journal
European journal of case reports in internal medicine
ISSN: 2284-2594
Titre abrégé: Eur J Case Rep Intern Med
Pays: Italy
ID NLM: 101648453
Informations de publication
Date de publication:
2020
2020
Historique:
received:
25
03
2020
accepted:
07
04
2020
entrez:
14
8
2020
pubmed:
14
8
2020
medline:
14
8
2020
Statut:
epublish
Résumé
Despite a recent decline, tuberculosis (TB) infection is still a frequent diagnosis in Portugal. Adenosine deaminase (ADA) measurement has become an important tool in the timely diagnosis of this infection. However, ADA elevation in bodily fluids is not pathognomonic of TB infection. We present the case of a 70-year-old woman, undergoing treatment for pleural TB, diagnosed based on elevated ADA levels in a pleural effusion. Due to worsening symptoms she was readmitted, and the previous diagnosis was reconsidered. Thoracocentesis was repeated and cytometry analysis of the fluid was performed, showing the presence of diffuse large B cell lymphoma (DLBCL). DLBCL is the most frequently occurring non-Hodgkin lymphoma (NHL). Pleural involvement is rare in the initial stages. ADA elevation >250 U/l should raise suspicion of malignancy, especially in association with markedly elevated LDH levels. The purpose of this case report is to highlight that in the absence of microbiologic or histologic confirmation, a presumptive TB diagnosis should not be lightly made, and alternative diagnoses should be systematically ruled out. Elevated ADA levels are not pathognomonic of TB infection.Lymphocytic pleural effusion requires a systematic diagnostic approach.Very high levels of ADA should arouse suspicion of lymphoma.
Identifiants
pubmed: 32789129
doi: 10.12890/2020_001633
pii: 1633-1-13229-1-10-20200505
pmc: PMC7417062
doi:
Types de publication
Journal Article
Langues
eng
Pagination
001633Informations de copyright
© EFIM 2020.
Déclaration de conflit d'intérêts
Conflicts of Interests: The Authors declare that there are no competing interests.
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