Challenging case of Anthracosis in a BK positive patient with transudative plural effusion

Background Anthracosis, a condition marked by the buildup of black pigments in the airways and lung tissue, is often seen in bronchoscopy, though its full clinical significance is still unclear. This case highlights an unusual presentation of transudative pleural effusion in a patient with both anthracosis and tuberculosis (TB), providing new insights into how these conditions may interact. Case Presentation An 83-year-old woman with a history of chronic obstructive pulmonary disease (COPD), and exposure to passive smoke presented with shortness of breath, a productive cough, fever, and fatigue. Imaging revealed a right-sided pneumothorax, transudative pleural effusion. Bronchoscopy showed anthracotic plaques. TB was confirmed through bronchoalveolar lavage (BAL). Conclusion This case highlights the importance of considering anthracosis in the diagnosis of atypical pleural effusions in TB patients. The potential connection between anthracosis and transudative pleural effusion is intriguing and warrants further investigation, which could influence future diagnostic approaches and treatment strategies.