Pleural tuberculosis occurs in 30% of patients with tuberculosis, and the percentage of patients with tuberculosis pleural effusions is comparable to human immunodeficiency virus HIV-positive and HIV-negative individuals, although pleural tuberculosis is rare in HIV-positive patients with CD4+ counts < 200 cells/mm(3). Pleural tuberculosis in HIV-positive patients is likely to happen in young patients, and is more frequent in intravenous drug abusers, with more acid-fast bacilli identifiable in pleural tissue. We report a rare case of pleural tuberculosis in a severely immunosuppressed HIV-positive patient, presented as two parasternum pleural-cutaneous fistula.
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