A 22-year-old man from a tuberculosis-endemic region presents with low-grade fever, night sweats, right-sided pleuritic chest pain, and breathlessness for 3 weeks. CXR shows moderate right-sided pleural effusion. Thoracentesis reveals an exudative effusion (lymphocyte-predominant, protein 5.2 g/dL, ADA 78 U/L). Pleural biopsy shows caseating granulomas. What is the recommended standard treatment duration?

• A 6 months of isoniazid and rifampicin alone
• B 2 months of isoniazid, rifampicin, pyrazinamide, ethambutol followed by 4 months of isoniazid and rifampicin ✓
• C 9 months of isoniazid and ethambutol
• D 2 months of isoniazid, rifampicin, pyrazinamide followed by 7 months of isoniazid and rifampicin

Explanation

Tuberculous pleuritis is treated with the same standard first-line anti-tuberculosis regimen as pulmonary TB: 2HRZE (isoniazid, rifampicin, pyrazinamide, ethambutol) intensive phase followed by 4HR continuation phase, totaling 6 months. This applies regardless of the site (pleural, lymph node, etc.). Extending treatment or omitting pyrazinamide/ethambutol is not standard. Indian RNTCP/NTEP guidelines follow the same 6-month regimen.

Reference: Harrison's Principles of Internal Medicine, 21st ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.