T-cell lymphoblastic lymphoma (T-LBL) is a rare and aggressive variant of non-Hodgkin lymphoma (NHL). We present a case of T-LBL presenting as a right-side pleural effusion in a middle-aged person and biochemical characteristics similar to tuberculosis [lymphocytic exudative with high adenosine deaminase (ADA)] that confuses the diagnosis and delays the treatment. Thoracoscopy was suggestive of multiple varying size nodular lesions which may be characteristic of the disease. This case also emphasizes that all lymphocytic exudative effusions with elevated ADA are not tuberculosis, especially in middle-aged and elderly populations. Before labeling a diagnosis of tubercular pleural effusions, all other possible diagnoses should be ruled out.
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