Mediastinal Lymphadenopathy Complicating into a Bronchonodal Fistula and Lung Abscess Formation – Rare Manifestation of Drug-resistant Tuberculosis

Abstract

Pulmonary tuberculosis (TB) sometimes involves regional lymph nodes like mediastinal lymph nodes. These may resolve spontaneously or on treatment; or they may enlarge and result in various complications such as extrinsic bronchial inflammation, ulceration, or rarely erode through the bronchial wall. This erosion is seen radiologically as mediastinal widening or lymphadenopathy with atelectasis and consolidation termed “epituberculosis.” This is more frequently encountered in infants than older children and extremely rarely in adults. We hereby describe a rare case of a 14-year-old girl with mediastinal lymphadenopathy complicating into a bronchonodal fistula and lung abscess formation. A diagnosis of pulmonary rifampicin-resistant TB was obtained on repeated testing of sputum for GeneXpert. The patient was started on appropriate drug-resistant TB therapy and completed therapy successfully.