%0 Journal Article
%T Use of anabolic-androgenic steroids masking the diagnosis of pleural tuberculosis: a case report
%A Carlos de Larrea
%A Aglae Duplat
%A Ismar Rivera-Olivero
%A Jacobus H de Waard
%J Journal of Medical Case Reports
%D 2009
%I BioMed Central
%R 10.1186/1752-1947-3-30
%X We report a case of pleural tuberculosis in a 31-year-old white male patient from Caracas, Venezuela who was negative for human immunodeficiency virus and presented 2 weeks after injecting the anabolic-androgenic steroid nandrolone decanoate, in whom all the tests for tuberculosis were initially negative; an eosinophilic pleural effusion with a low adenosine deaminase level, a negative tuberculin skin test and negative for acid-fast bacilli staining and culture of the pleural fluid. After excluding other causes of eosinophilic pleural effusion malignant pleural effusion was suspected. The patient did not return until 4 months later. The second thoracentesis obtained a pleural fluid suggestive for tuberculosis, with a predominance of lymphocytes, an elevated adenosine deaminase level (51 U/l) and a positive tuberculin skin test. Culture of pleural fragments confirmed pleural tuberculosis.This case suggests that the use of an anabolic-androgenic steroid masks the definitive diagnosis of pleural tuberculosis by changing the key diagnostic parameters of the pleural fluid, a finding not previously reported. Available evidence of the effects of anabolic steroids on the immune system also suggests that patients using anabolic-androgenic steroids might be susceptible to developing tuberculosis in either reactivating a latent infection or facilitating development of the disease after a recent infection.The cause of an exudative pleural effusion (EPF) is often difficult to determine, but tuberculosis (TB) must be considered, especially in countries with a high prevalence of TB. The diagnosis of a tuberculous pleural effusion is based on the Ziehl-Neelsen staining for acid-fast bacilli (AFB) and on the growth of Mycobacterium tuberculosis from pleural fluid or biopsy. However, if no AFB are found, cultures take 4¨C6 weeks to be positive, and therapeutic decisions need to be made before the results are available. A positive tuberculin skin test (TST) can be helpful, but may be n
%U http://www.jmedicalcasereports.com/content/3/1/30