Non-Hodgkin's lymphoma-associated pleural effusion misdiagnosed as tubercular pleural effusion

Adenosine deaminase (ADA) in the pleural fluid has high sensitivity and specificity for diagnosing tubercular pleuritis. ADA level of more than 40 IU/L in a lymphocytic and exudative effusion is suggestive of tubercular etiology in clinical practice. Antitubercular chemotherapy is often instituted without further histopathological or microbiological confirmation, especially in tuberculosis (TB)-endemic countries. Lymphoma is another important cause of elevated ADA levels in pleural fluid. Hence, in the absence of tissue diagnosis, lymphoma is often wrongly labeled as TB based on fluid characteristics. Here, we present a case of non-Hodgkin lymphoma with right-side pleural effusion who was initially misdiagnosed to have TB based on pleural fluid analysis