Abstract
Tuberculous infection of the tracheobronchial tree, termed as endobronchial tuberculosis (EBTB), is more common in young adults and females. This clinical entity is poorly understood and the diagnosis is frequently delayed as sputum smears are often negative for acid fast bacilli and the chest radiograph can be normal, resulting in diagnostic confusion. Bronchoscopy continues to play a key role in its diagnosis. Though atelectasis is not uncommon in these patients, EBTB presenting as a middle lobe syndrome (MLS) has rarely been documented. MLS refers to chronic or recurrent collapse of the right middle lobe and has a myriad of causes. The pathogenesis of this entity too is not fully established. We report this exceptional clinical manifestation in a 19-year-old male, who presented for evaluation of respiratory symptoms for 6 months along with constitutional complaints. Imaging suggested the presence of MLS and bronchoscopy established the diagnosis of endobronchial tuberculosis. GeneXpert evaluation of bronchial aspirate detected Mycobacterium tuberculosis. Histopathology confirmed the presence of granulomatous lesions. Subsequently, the cultures of bronchial aspirate and post-bronchoscopy sputum grew M. tuberculosis. Appropriate therapy with anti-tuberculosis drugs resulted in a remarkable symptomatic and radiological improvement. EBTB presenting as a MLS is a distinct rarity.
Highlights
Tuberculous infection of the tracheobronchial tree is known as endobronchial tuberculosis (EBTB) and in patients with active pulmonary tuberculosis, its frequency ranges from 10−50% [1−3]
Bronchial stenosis is a well-known and dreaded complication of EBTB which can result in atelectasis and obstructive pneumonia
A diagnosis of endobronchial tuberculosis presenting as a MLS was made on the basis of the following: 1) on bronchoscopy, the middle lobe bronchial mucosa was oedematous, hyperaemic with cheesy whitish tenacious secretions emanating from the narrowed middle lobe (Fig. 3) suggestive of actively caseating type of lesions [11], 2) positive GeneXpert, 3) transbronchial biopsy confirming granulomatous inflammation, 4) subsequent isolation of Mycobacterium tuberculosis from bronchial aspirate and post-bronchoscopy sputum and 5) characteristic radiological presentation suggestive of right middle lobe syndrome
Summary
Tuberculous infection of the tracheobronchial tree is known as endobronchial tuberculosis (EBTB) and in patients with active pulmonary tuberculosis, its frequency ranges from 10−50% [1−3]. A search of the literature revealed only 2 reports documenting 25 patients with EBTB who presented with MLS [9, 10]. High resolution contrast enhanced computed tomography (CECT) of the thorax revealed mediastinal lymphadenopathy compressing the right middle lobe bronchus (Fig. 2A: mediastinal window) accompanied by a trapezoidal opacity with its base towards the hilum and contiguous with the right cardiac border confirming the presence of MLS (Fig. 2B: mediastinal window).
Sign-in/Register to view highlights & summary Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
