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Case Report A 40 years male presented with history of 2 month dyspnoea, cough with expectoration and palpitations. His vitals were stable except for respiratory rate : 28/min; saturation was 90%. On examination, bronchial breathing was present over right upper lobe with diffuse rhonchi all over the lung fields. Sputum was AFB positive. Radiological investigation showed cavity in right upper zone. Patient was diagnosed as a case of pulmonary tuberculosis and ATT was started. After 3 weeks of treatment, patient dyspnea increased. Chest x-ray was done which showed left sided pleural effusion. Pleurocentesis was performed and showed:colour was orange tinged. Gram and AFB (acid-fast bacilli) staining of the pleural fluid were negative. The pH of the fluid was 7.2; WBC count, 80 cells/mm3 [69% polymorphonuclear leukocytes (PMNs), 23% monocytes]; total fluid protein, 4.3 g/dL; LDH (lactate dehydrogenase), 1250 IU/L; and glucose, 10 mg/dL. At the same time, the total serum protein was 6.9 g/dL; serum LDH was 566 IU/L.ADA (adenosine deaminase) level was 20(normal ) and ANA (antinuclear antibodies) of the fluid came out to be positive.INH was discontinued and rifampin was started for latent tuberculosis treatment. Over the next few days, his dyspnea improved, his cough resolved. On hospital day 20, further testing revealed positive double-stranded DNA (dsDNA) antibodies he was started on oral prednisone for drug-induced lupus, likely secondary to INH therapy.After 25 total days of hospitalization, the patient was discharged on oral prednisone (as well as his other medications). A repeat chest radiograph done 2 weeks later showed complete resolution of the pleural effusion

Atypical Presentation of Isoniazid induced Left Sided Pleural Effusion in Case of Right Sided Koch’s on Anti-Tubercular Drugs: Case Report