A Tracheobronchial Tuberculosis Patient With Diffuse Nodules in the Tracheobronchial Mucosa Observed by Bronchoscopy Misdiagnosed as Lung Infection

Abstract

Tracheobronchial tuberculosis (TBTB) is a special form of pulmonary tuberculosis (TB) whose major feature is the infection of the tracheobronchial tree by Mycobacterium tuberculosis . TBTB is diagnosed on histopathological examination of bronchoscopically obtained specimens showing granulomatous inflammation with caseation necrosis and/or positive acid-fast bacilli culture on the microbiological exam. Before bronchoscopy, TBTB is easily misdiagnosed as other lung diseases. This case presentation reports a patient with stable stage pulmonary tuberculosis (PTB) initially misdiagnosed as lung infection before bronchoscopy. Furthermore, sputum smears do not reveal acid-fast bacilli. After being bronchoscopied, the patient showed diffuse nodules in the tracheobronchial mucosa. Sputum culture by rapid liquid method shows positive Mycobacterium tuberculosis . This case can easily be missed diagnosis. It is necessary that bronchoscopy can be a routine means to screen TBTB among the patients with retreated PTB. One rare case was reported. Bronchoscopy showed the presence of diffuse miliary nodules in the mucosa of bilateral bronchi. Pathological examination revealed caseating necrotic granuloma. Mycobacterium tuberculosis was detected by rapid liquid culture. Our case was extremely difficult to diagnose the TBTB without abnormal chest X-ray or computed tomography manifestations. By regular anti-TB treatment with 9 months course, the patient was finally cured with negative Mycobacterium tuberculosis and almost normal tracheobronchial mucosa. Clin Infect Immun. 2018;3(1):32-35 doi: https://doi.org/10.14740/cii78e