{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,26]],"date-time":"2026-03-26T07:56:58Z","timestamp":1774511818117,"version":"3.50.1"},"reference-count":18,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2026,3,8]],"date-time":"2026-03-08T00:00:00Z","timestamp":1772928000000},"content-version":"vor","delay-in-days":7,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,3,1]],"date-time":"2026-03-01T00:00:00Z","timestamp":1772323200000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Clinical Case Reports"],"published-print":{"date-parts":[[2026,3]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:p>\n                    Pleural tuberculosis is a common manifestation of extrapulmonary tuberculosis; however, its diagnosis remains challenging in paucibacillary disease, where clinical presentation may be atypical and microbiological tests frequently yield negative results. We report the case of a 27\u2010year\u2010old Syrian male who presented with a one\u2010year history of left\u2010sided pleuritic chest pain and unintentional weight loss. Imaging studies revealed left\u2010sided pleural\u2010based subpleural nodules with mild metabolic activity. Repeated sputum acid\u2010fast bacilli smears, polymerase chain reaction testing for\n                    <jats:styled-content style=\"fixed-case\">\n                      <jats:italic>Mycobacterium tuberculosis<\/jats:italic>\n                    <\/jats:styled-content>\n                    , and bronchoscopy were all negative. Due to persistent clinical suspicion, thoracoscopic exploration was performed, revealing multiple subpleural nodules on both the parietal and visceral pleura. Histopathological examination demonstrated necrotizing granulomatous inflammation with caseous material, consistent with pleural tuberculosis. The patient was treated with a standard six\u2010month antituberculous regimen and showed favorable clinical recovery. Pleural tuberculosis represents a diagnostic challenge due to its frequent paucibacillary nature and nonspecific clinical presentation, which often results in low sensitivity of conventional microbiological and molecular tests such as direct smears using Ziehl\u2013Neelsen and Auramine staining. In this case, prolonged pleuritic chest pain with minimal systemic symptoms and repeatedly negative sputum smears and PCR delayed microbiological confirmation. Definitive diagnosis was achieved only through thoracoscopic pleural biopsy and histopathological examination. This highlights the limitations of noninvasive investigations in pleural TB and underscores the importance of early escalation to pleural biopsy when clinical suspicion persists despite inconclusive results. This case highlights pleural tuberculosis presenting as subpleural nodules as a diagnostic challenge in the setting of negative microbiological tests. Maintaining a high index of suspicion and early escalation to tissue diagnosis are essential to ensure timely treatment and prevent misdiagnosis.\n                  <\/jats:p>","DOI":"10.1002\/ccr3.72205","type":"journal-article","created":{"date-parts":[[2026,3,8]],"date-time":"2026-03-08T22:40:56Z","timestamp":1773009656000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Paucibacillary Pleural Tuberculosis Presenting as Subpleural Nodules: A Diagnostic Challenge With Negative\n                    <scp>PCR<\/scp>\n                    and Smear Tests"],"prefix":"10.1002","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0009-0009-3563-4103","authenticated-orcid":false,"given":"Omar","family":"Al Ayoubi","sequence":"first","affiliation":[{"name":"Faculty of Medicine Damascus University  Damascus Syrian Arab Republic"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-9600-6326","authenticated-orcid":false,"given":"Mohammad Alaa","family":"Aldakak","sequence":"additional","affiliation":[{"name":"Faculty of Medicine Damascus University  Damascus Syrian Arab Republic"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-9318-6804","authenticated-orcid":false,"given":"Bassel","family":"Ibrahim","sequence":"additional","affiliation":[{"name":"National University Hospital, Damascus University  Damascus Syrian Arab Republic"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0000-1480-0365","authenticated-orcid":false,"given":"Raneem","family":"Ahmad","sequence":"additional","affiliation":[{"name":"National University Hospital, Damascus University  Damascus Syrian Arab Republic"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Youness","family":"Souleiman","sequence":"additional","affiliation":[{"name":"National University Hospital, Damascus University  Damascus Syrian Arab Republic"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2026,3,8]]},"reference":[{"key":"e_1_2_12_2_1","unstructured":"FLHealthCHARTS \u201cTuberculosis (TB) \u201d(2025) cited July 2025 https:\/\/www.flhealthcharts.gov\/ChartsDashboards\/rdPage.aspx?rdReport=NonVitalIndNoGrp.Dataviewer&cid=148."},{"key":"e_1_2_12_3_1","unstructured":"Centers for Disease Control and Prevention \u201cTuberculosis \u201dIn: CDC Yellow Book 2024: Travel\u2010Associated Infections and Diseases (2024) cited August 2025 https:\/\/www.cdc.gov\/yellow\u2010book\/hcp\/travel\u2010associated\u2010infections\u2010diseases\/tuberculosis.html."},{"key":"e_1_2_12_4_1","doi-asserted-by":"publisher","DOI":"10.22088\/cjim.15.4.735"},{"key":"e_1_2_12_5_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12865\u2010019\u20100315\u2010y"},{"key":"e_1_2_12_6_1","doi-asserted-by":"publisher","DOI":"10.7759\/cureus.85085"},{"key":"e_1_2_12_7_1","doi-asserted-by":"publisher","DOI":"10.1002\/ccr3.71026"},{"issue":"3","key":"e_1_2_12_8_1","first-page":"607","article-title":"Effects of Household Bleach on Sputum Smear Microscopy to Concentrate Acid Fast Bacilli for the Diagnosis of Pulmonary Tuberculosis","volume":"32","author":"Rasool G.","year":"2018","journal-title":"Journal of Biological Regulators and Homeostatic Agents"},{"key":"e_1_2_12_9_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jped.2022.03.006"},{"key":"e_1_2_12_10_1","doi-asserted-by":"publisher","DOI":"10.7759\/cureus.3513"},{"key":"e_1_2_12_11_1","doi-asserted-by":"publisher","DOI":"10.1111\/crj.12900"},{"key":"e_1_2_12_12_1","doi-asserted-by":"publisher","DOI":"10.1136\/thx.52.2.187"},{"issue":"5","key":"e_1_2_12_13_1","first-page":"306","article-title":"Pleuritic Chest Pain: Sorting Through the Differential Diagnosis","volume":"96","author":"Reamy B. V.","year":"2017","journal-title":"American Family Physician"},{"key":"e_1_2_12_14_1","doi-asserted-by":"publisher","DOI":"10.1002\/14651858.CD012768.pub3"},{"key":"e_1_2_12_15_1","doi-asserted-by":"publisher","DOI":"10.1128\/spectrum.01632\u201022"},{"key":"e_1_2_12_16_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijid.2021.05.023"},{"key":"e_1_2_12_17_1","doi-asserted-by":"publisher","DOI":"10.1111\/resp.13275"},{"key":"e_1_2_12_18_1","doi-asserted-by":"publisher","DOI":"10.1007\/s40477\u2010025\u201001094\u20109"},{"key":"e_1_2_12_19_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1440\u20101843.2010.01723.x"}],"container-title":["Clinical Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/ccr3.72205","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1002\/ccr3.72205","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/ccr3.72205","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,3,26]],"date-time":"2026-03-26T06:08:13Z","timestamp":1774505293000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1002\/ccr3.72205"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,3]]},"references-count":18,"journal-issue":{"issue":"3","published-print":{"date-parts":[[2026,3]]}},"alternative-id":["10.1002\/ccr3.72205"],"URL":"https:\/\/doi.org\/10.1002\/ccr3.72205","archive":["Portico"],"relation":{},"ISSN":["2050-0904","2050-0904"],"issn-type":[{"value":"2050-0904","type":"print"},{"value":"2050-0904","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,3]]},"assertion":[{"value":"2025-12-15","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-02-23","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-03-08","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e72205"}}