Overview
Pleurisy, characterized by inflammation of the pleura, often presents with sharp chest pain that worsens with breathing. It can be associated with pleural effusion and may result from various etiologies including infections like tuberculosis 1.Diagnosis
Key Diagnostic Criteria: Elevated pleural fluid ADA activity is typically seen in tuberculous pleurisy, though low ADA levels can occur, particularly in elderly patients with multi-organ failure 1.
Recommended Tests: Pleural fluid analysis including ADA activity, cell count, and microbiological studies for definitive diagnosis 1.
Grading: Sequential Organ Failure Assessment (SOFA) score can help identify severity, especially in critically ill patients 1.Management
First-Line Treatments: Indomethacin (50 mg every 8 hours) can provide good to excellent relief of pleural pain in selected patients 2.
Adjunctive Treatments: Specific adjunctive therapies are not detailed in the provided abstracts, but management often includes addressing underlying causes (e.g., antitubercular therapy for TB) 1.Special Populations
Elderly: Elderly patients with multi-organ failure may present with low ADA activity in tuberculous pleurisy, necessitating careful clinical assessment 1.
Comorbidities: Critically ill patients with multi-organ failure require vigilant monitoring due to atypical presentations like low ADA levels 1.Key Recommendations
Consider low ADA activity in elderly and critically ill patients with suspected tuberculous pleurisy, warranting thorough clinical evaluation 1 (Evidence: Moderate).
Indomethacin can be a reasonable initial choice for pain management in pleurisy, though monitor for potential serious side effects 2 (Evidence: Weak).
Utilize SOFA scores to assess severity in critically ill patients presenting with pleuritic symptoms 1 (Evidence: Moderate).References
1 Kim SB, Shin B, Lee JH, Lee SJ, Lee MK, Lee WY et al.. Pleural fluid ADA activity in tuberculous pleurisy can be low in elderly, critically ill patients with multi-organ failure. BMC pulmonary medicine 2020. link
2 Klein RC. Effects of indomethacin on pleural pain. Southern medical journal 1984. link