Dr Hadda and colleagues have presented an interesting case highlighting a less common presentation of tuberculosis. However, I am surprised that their most likely diagnosis was pleural malignancy.

Malignancy might have been likely if one only had the radiological picture but I have not seen many 17-year olds with pleural malignancy, particularly those presenting with fever and weight loss - I am sure others will agree. The only malignancy that might give this picture is a lymphoma.

Diseases don't read books, I am afraid, so they might not know that tuberculosis is not listed as a cause in Fishman's pulmonary diseases and disorders.

Competing interests: None declared