Background: Tuberculous pleural effusion (TPE) is a common form of extrapulmonary tuberculosis (EPTB), particularly in TB-endemic regions. The management of TPE is complicated by issues of recurrence and drug resistance, especially in diverse patient populations including those with HIV co-infection.

Methods: This retrospective case series examines two cases of pleural effusion due to tuberculosis: one in an immunocompetent 25-year-old female and another in a 35-year-old HIV-positive male with multidrug-resistant TB (MDR-TB). Both cases highlight diagnostic challenges, treatment responses, and the need for tailored therapeutic approaches.

Results

1. Case 1: The 25-year-old female presented with symptoms of fever, chest pain, and weight loss. She was initially treated successfully with standard anti-TB therapy. However, she experienced a recurrence of pleural effusion after one year, which was managed with a second course of anti-TB treatment, resulting in improvement.

2. Case 2: The HIV-positive male presented with low-grade fever and significant weight loss. Initial diagnostics revealed rifampicin-resistant TB, and he was treated with a complex regimen including Bedaquiline. Despite treatment, he developed further resistance and significant side effects, necessitating multiple regimen adjustments. He ultimately completed 18 months of treatment with a modified regimen.

Conclusion: This case series underscores the complexity of managing TB pleural effusion, particularly in the context of recurrence and drug resistance. The immunocompetent patient’s recurrence highlights the need for vigilant follow-up and potentially extended treatment durations. The HIV-positive patient’s case demonstrates the challenges of treating MDR-TB with associated drug toxicity and evolving resistance. Successful outcomes depend on comprehensive diagnostics, individualized treatment plans, and close monitoring to address complications and ensure effective management.