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A 68 year-old male who was ex-smoker presented with fever and cough. Chest radiograph showed infiltrative shadows in both upper lung fields. A sputum smear for acid-fast bacilli was positive. But the isolate was not identified by polymerase chain reaction method. Acid-fast bacilli were cultured from sputum, but the identification was not done by DNA-DNA hybridization method. Mycobacterium shimoidei was identified by 16S ribosomal RNA sequencing with 98.42% matching. Rifampicin, ethambutol, clarithromycin, pyrazinamide, and ciprofloxacin were administered, and the symptom and abnormal shadows on chest radiography improved. And three months later from the initiation of treatment, sputum smear for acid-fast bacilli became negative. Chest CT scan four months after treatments showed decrease of infiltrative shadows. We had treated him for six months, and after that no recurrence occurred.

We examined the usefulness of adenosine deaminase 2 (ADA2) in the diagnosis of tuberculous pleuritis.A hundred cases, 78 male and 22 female, with pleural effusion were examined. With regard to pleural effusion, 18 cases were transudate and 82 cases (9 tuberculous pleuritis, 27 lung cancer, 8 mesothelioma, 5 malignant diseases except lung cancer and mesothelioma, 5 benign asbestos pleurisy, 10 empyema, 10 parapneumonic effusion, one SLE, one parasitic infection, and 6 undetermined etiology) were exudates. The last 6 cases with unknown origin were excluded in this study.Pleural adenosine deaminase (ADA) was 90.4 +/- 22.4 U/l (mean +/- SD) and pleural ADA2 was 80.4 +/- 21.9 U/l in tuberculous pleuritis, both were significantly higher than those in non-tuberculous exudates (p0.001). In the diagnosis of tuberculous pleuritis, pleural ADA showed 100% sensitivity and 88% specificity, whereas pleural ADA2 showed 100% sensitivity and 91% specificity.Pleural ADA2 is useful in the diagnosis of tuberculous pleuritis, which has similar sensitivity and a little better specificity compared with pleural ADA.