Paper Title
Diagnostic Dilemma in an Atypical Presentation of Tuberculous Pleural Effusion

Abstract
Tuberculosis (TB) is one of the most prevalent infectious diseases infecting almost half of Nepalese population and a significant public health problem in Nepal. Its burden is increasing due to co-infection in HIV infected patients. Extra pulmonary TB accounts about 25-30% of all TB cases in Nepal. Gold standard for diagnosis of TB is by bacteriological confirmation in specimen; however it is not always possible in resource limited settings like ours. Atypical presentation makes the diagnosis more challenging. Judicious use of investigations and clinical judgment are mandatory in diagnostic dilemmas. In the parts of the world with high prevalence of TB, increased ADA level of pleural fluid >50U/L and response of symptoms to anti-tubercular therapy helps in diagnosing tuberculous pleural effusion in view of minimal clinical suspicion of other causes of exudative pleural effusion. We report a case of a 42 years lady with an atypical presentation of tuberculous pleural effusion, who went through a tough and distressing time for her diagnosis and treatment. Keywords - Atypical presentation, Tuberculous pleural effusion, Diagnostic dilemma, ADA