Abstract
Background: Endotracheal and endobronchial tuberculosis are defined by microbiological and histopathological evidence of tuberculosis involving tracheobronchial tree, with or without parenchymal involvement. Tracheal tuberculosis is a rare and localized form of tuberculosis which can present itself with acute respiratory failure due to upper airway obstruction. Case presentation: We present a case of a 62 year old female with a diagnosis of pulmonary tuberculosis, who was admitted to the emergency department of our hospital with severe dyspnea, which rapidly progressed to acute respiratory failure requiring tracheal intubation and mechanical ventilation. A four-drug anti-tuberculosis (TB) regimen, consisting of isoniazid, rifampicin, pyrazinamide and ethambutol, was started one month before and identification of a sensitive Mycobacterium tuberculosis strain was made at that time. During medical investigation, tracheobronchial tuberculosis and endotracheal aspergillosis co-infection were diagnosed by bronchoscopy and histological examination. Conclusion: This uncommon case illustrates a severe clinical presentation of tracheobronchial tuberculosis with concomitant diagnosis of tracheal aspergillosis. It underlines the importance of a prompt diagnosis and treatment of tracheal tuberculosis and co-incidental infections in order to prevent serious complications, such as bronchostenosis and bronchomalacia. The bronchoscopic examination is the key for microbiological and histopathological confirmation of tracheobronchial involvement for both tuberculosis and aspergillosis. Corticosteroid therapy combined with anti-TB regimen remains controversial for endobronchial TB and its impact on patients’ outcome is not well documented.
Highlights
Endotracheal and endobronchial tuberculosis are defined by microbiological and histopathological evidence of tuberculosis involving tracheobronchial tree, with or without parenchymal involvement
This uncommon case illustrates a severe clinical presentation of tracheobronchial tuberculosis with concomitant diagnosis of tracheal aspergillosis. It underlines the importance of a prompt diagnosis and treatment of tracheal tuberculosis and co-incidental infections in order to prevent serious complications, such as bronchostenosis and bronchomalacia
Corticosteroid therapy combined with anti-TB regimen remains controversial for endobronchial TB and its impact on patients’ outcome is not well documented
Summary
This case illustrates a severe clinical presentation of tracheobronchial tuberculosis with acute respiratory failure, with concomitant diagnosis of tracheal aspergillosis. This co-infection with the involvement of the tracheobronchial tree may have been responsible for the development of severe sequelae in this patient, inclunding lower tracheomalacia and right bronchomalacia with persistent diameter reduction. The author’s purpose in writing this case report was to highlight the importance of prompt diagnosis and treatment of ETB and coincidental infections in order to achieve eradication of tubercle bacilli and to prevent serious complications and long term sequelae associated with delay in diagnosis, such as bronchostenosis and bronchomalacia. Written consent was obtained from the patient for publication of this Case report and any accompanying images. A copy of the written consent is available for review by the editor of this journal
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