• Daizo Yaguchi, Motoshi Ichikawa, Masato Shizu, Noriko Inoue, Daisuke Kobayashi, Naoyuki Imai, and Masao Ito.
• Department of Respiratory Medicine Department of Thoracic Surgery, Gifu Prefectural Tajimi Hospital, Tajimi, Gifu, Japan.
• Medicine (Baltimore). 2018 May 1; 97 (20): e10811e10811.

RatonaleSometimes, pleural effusion accompanying an acute Mycoplasma pneumoniae infection or tuberculous pleurisy has similar analysis results. We report a case of tuberculous pleurisy which was initially diagnosed as acute M pneumoniae infection, which is of special interest because anti-Mycoplasma antibody results were positive, which served as a red herring.Patient ConcernsA 20-year-old woman visited the outpatient emergency romm of our hospital for chief complaints of high fever, dry cough, and pleuralgia persiting for 2 days. Since anti-mycoplasma antibody test results were positive, we treated acute M pneumoniae infection and drained her pleural effusion. The condition tended to improve, but on day 16 postadmission, the acid-fast bacterial culture of the pleural effusion was positive for Mycobacterium tuberculosis.DiagnosesTuberculous pleurisy.InterventionsAfter the diagnosis, the patient received antituberculous drugs.OutcomesShe completed treatment with no noticeable adverse events, and the right pleural effusion disappered and diffuse right pleural thickening improved.LessonsExudative pleural effusion with lymphocyte dominance and a high adenosine deaminase level in M pneumoniae infection have been reported. Even though the condition suggests acute M pneumoniae infection, clinicians should be aware that tuberculous pleurisy and M pneumoniae infection can share similar clinical features, and should understand the usefulness and limitations of the anit-Mycoplasma antibody test.

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