A Case Report of an Endobronchial Tuberculosis-Challenges in Diagnosis and the Role of High-resolution CT Scans and Bronchoscopic Biopsy

Abstract

Introduction:: Endobronchial tuberculosis is a challenging disease to diagnose, characterized by infection of the tracheobronchial tree caused by Mycobacterium Tuberculosis. The clinical presentation of endobronchial tuberculosis is nonspecific and variable, making it difficult to identify. Case Report:: This report explores the challenges faced during the diagnosis of endobronchial tuberculosis by a 63-year-old female patient presented with a chronic cough lasting over two months. Her chest X-ray revealed an inhomogeneous opacity in the left middle zone, accompanied by an air-bronchogram. Conventional sputum samples and other tests returned negative results. A high-resolution chest CT scan was almost complete consolidation in the lingular subsegment. A comprehensive re-evaluation was recommended in this case due to slow re-solving or non-resolving pneumonia. The histopathological examination of the biopsy sample revealed granulomatous inflammation with necrosis and lymphocytic infiltration, strongly indicating bronchial tuberculosis. The Hain test and MGIT culture confirmed the presence of Mycobacterium tuberculosis. Conclusion:: Diagnosing endobronchial tuberculosis can be challenging due to its nonspecific and variable clinical presentation. High-resolution CT scans provide valuable insights, but the absence of typical findings can complicate the diagnosis. Bronchoscopic biopsy proved to be the most reliable method for diagnosing endobronchial tuberculosis in this case. Early and accurate diagnosis is crucial for initiating appropriate treatment and preventing complications.