Short course of high dose steroids used for non-pulmonary indication like anaphylaxis caused flare up of tuberculosis & presenting as acute pulmonary tuberculosis with pleural effusion: a case report

Tuberculosis (TB) remains a major health problem in India, and accounts for nearly 20-30% of the global TB burden. Prevalence of tuberculosis infection in India is 40%, with pulmonary tuberculosis accounts for 80% cases, and in immune-competent individuals 5 to 10% chance of TB progressing from infection to disease during their lifetimes. Data is available for possible role of steroids used for pulmonary and non-pulmonary indications in increasing risk of new tuberculosis infection, reactivation of latent tuberculosis infection and relapse of treated disease. In this case report, 25 year male received high dose intravenous steroids for life threatening anaphylaxis because of bee sting bite only for four days caused reactivation of latent tuberculosis infection (LTBI). Clinical presentation is acute form of progressive pulmonary tuberculosis with pleural effusion which can be misdiagnosed as a community acquired pneumonia. High index of suspicion with adequate evaluation is must in all cases to have satisfactory treatment outcome.