Reply: IgG4-Related Pleuritis Without Tuberculous Pleurisy

The comments of Dr. Jolobe regarding the need to include Mycobacterium tuberculosis infection as part of the differential diagnosis of patients with IgG4-related disease are very much appreciated, especially when considering cases of IgG4-related disease with pleural effusion, where the clinical course should be considered along with serum IgG4 levels and pleural histology. 1 Suzuki N Saeki T Shimaoka Y et al. Two cases of IgG4-related disease with pleural effusion. Nihon Kokyuki Gakkai Zasshi. 2011; 49 ([article in Japanese, Abstract in English]): 97-102 PubMed Google Scholar The diagnosis of tuberculous pleuritis depends on the results of the examination of sputum, pleural fluid or biopsy specimens, which are obtained using acid-fast microscopy, bacterial culture, polymerase chain reaction (PCR), evaluation of pleural fluid characteristics or histopathology. 2 Light RW Establishing the diagnosis of tuberculous pleuritis. Arch Intern Med. 1998; 158: 1967-1968 Crossref PubMed Scopus (30) Google Scholar In 84 patients with pleural tuberculosis, Conde et al 3 Conde MB Loivos AC Rezeehde VM et al. Yield of sputum induction in the diagnosis of pleural tuberculosis. Am J Respir Crit Care Med. 2003; 167: 723-725 Crossref PubMed Scopus (154) Google Scholar reported a bacteriologic yield of 62% (52/84) for pleural tissue, 12% (10/84) for pleural fluid and 52% (44/84) for sputum cultures obtained by sputum induction. In a study by Casalini et al 4 Casalini AG Mori PA Majori M et al. Pleural tuberculosis: medical thoracoscopy greatly increases the diagnostic accuracy. ERJ Open Res. 2018; 4: 00046-02017https://doi.org/10.1183/23120541.00046-2017 Crossref PubMed Scopus (26) Google Scholar using medical thoracoscopy, mycobacterial cultures of pleural biopsies were positive in 63% of cases (29/46), and pleural histology was relevant in all patients.