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Pulmonary puzzles
A very strange tail
  1. Ambika Talwar1,
  2. Anne McGown1,
  3. Tracy Langham1,
  4. Muhammad Abid2,
  5. John Pilling3
  6. on behalf of the Department of Respiratory Medicine, Royal Berkshire Hospital
  1. 1Royal Berkshire Hospital, Reading, UK
  2. 2Thames Valley Public Health England Centre, Oxfordshire, UK
  3. 3Department of Thoracic Surgery, Guys and St Thomas's Trust, London, UK
  1. Correspondence to
    Ambika Talwar, Respiratory Department, Royal Berkshire Hospital, London Road, Reading, UK; ambitalwar{at}

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A young couple both presented in the autumn of 2013 with a protracted flu-like illness, right-sided pleuritic chest pain and night sweats. Neither had any significant past illnesses nor had they travelled abroad recently.

Patient X (aged 18 years) was systemically well with no extrapulmonary abnormalities on examination. Her C-reactive protein was elevated at 46 with a normal white cell count and negative blood cultures. She was not immunocompromised. Chest X-ray and thoracic ultrasound revealed a small right-sided pleural effusion. She was extremely needle phobic, and so pleural aspiration was not performed. She was treated for pneumonia with a 4-week course of oral antibiotics and clinically improved.

Patient Y (aged 20 years) presented to chest clinic 1 month later. On examination, he was septic. Chest X-ray, thoracic ultrasound and pleural aspiration confirmed that he had a right-sided empyema. He was admitted and treated with intravenous antibiotics and an intercostal …

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  • Contributors AT wrote the case report. AM supervised the writing of the case report. MA ensured the case management and case report were submitted in accordance with public health policy. JP performed the VATS biopsy on the patients enabling tissue diagnosis of M bovis. TL is our TB specialist nurse who managed the patients on a day-to-day level following hospital discharge and obtained patient consent for the writing of this case for publication. Consent to publish the case and images has been obtained from the cat owner and the patients. The overall guarantor for the case is jointly AT and AM.

  • Competing interests None.

  • Patient consent Obtained.

  • Provenance and peer review Not commissioned; internally peer reviewed.

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