SESSION TITLE: Chest Infections 1 SESSION TYPE: Med Student/Res Case Rep Postr PRESENTED ON: 10/09/2018 01:15 PM - 02:15 PM INTRODUCTION: Anterior Segment Tuberculosis (ASTB) is an uncommon manifestation of pulmonary tuberculosis (TB). The incidence of localized anterior segment involvement is approximately 2.8%, occurring mostly in children, often associated with primary pulmonary TB. The incidence of ASTB in reactivation TB is low. We describe a case of an elderly patient with reactivation pulmonary TB infection, presenting with endobronchial tuberculosis (EBTB) with right anterior segment involvement. CASE PRESENTATION: A 95-year-old Caucasian female was evaluated for 1-2 weeks of non-productive cough and new intermittent wheezing. Her symptoms improved with bronchodilators. Past medical history is unremarkable. She lived all her life in Omaha, Nebraska prior to moving to New York State 5 years prior to admission. She is a never smoker, previously worked as a secretary, and her only international travel was to Mexico in the 1960s. Review of systems was negative for hemoptysis, weight loss, fever, chills or chest pain. Physical exam revealed a nourished woman who was not ill appearing with focal crackles in the right anterior parasternal chest. Laboratory exam showed hemoglobin 11.0 g/dL and serum sodium 139 mEq/L. Chest X-ray revealed a right upper lobe opacity, mostly perihilar [Figure 1]. CT chest showed a mass encasing the right upper lobe bronchus leading to anteromedial right upper lobe atelectasis, with multiple right subpleural nodules and right hilar lymphadenopathy [Figure 2]. Bronchoscopy was performed, with bronchial alveolar lavage (BAL) PCR positive for Mycobacterium tuberculosis and Mycobacterium avium complex. Patient was diagnosed with EBTB causing ASTB. She was started on Isoniazid, Pyrazinamide, Ethambutol and Rifampin. Prednisone was used as adjunctive therapy for endobronchial involvement; and after two weeks of therapy her chest x-ray had normalized and she had no local rales or wheezing. DISCUSSION: Both ASTB and EBTB are rare in adults. Cases of ASTB occur more often with primary TB infection in children. Infrequently, reactivation of TB may present as anterior segment disease. Uniquely, our 95-year-old patient also had endobronchial involvement. The prevalence of EBTB is 10-40% in patients with active pulmonary tuberculosis, and 90% of these patients will develop some degree of bronchial stenosis. The pathogenesis of EBTB is unclear, and diagnosis is frequently delayed until bronchial stenosis, atelectasis, and bronchiectasis are present. The most common bronchoscopic finding in EBTB is inflamed mucosa. The use of steroids to minimize bronchial stenosis remains controversial. CONCLUSIONS: Anterior Segment Tuberculosis and Endobronchial Tuberculosis are uncommon presentations of a common disease. Diagnosis is challenging due to rarity in the elderly population, nonspecific clinical presentation, and atypical radiographic findings. Reference #1: Kashyap, Surender et. Al. Endobronchial Tuberculosis. Indian J Chest Dis Allied Sci 2003; 45: 247-256. Reference #2: Rikimaru, Toru. Therapeutic Management of Endobronchial Tuberculosis. Expert Opinion on Pharmacotherapy. Vol. 5, ISS. 7, 2004. Reference #3: Spencer, David et. al. Anterior Segment Upper Lobe Tuberculosis in the Adult: Occurrence in Primary and Reactivation Disease. Chest. Vol 97, ISS.2, 1990. DISCLOSURES: No relevant relationships by richard blinkhorn, source=Web Response No relevant relationships by Hau Chieng, source=Web Response No relevant relationships by Shannon Murawski, source=Web Response No relevant relationships by Biplab Kumar Saha, source=Web Response