Endobronchial tuberculosis—is corticosteroid treatment useful? A report of 8 cases and review of the literature

Chan, H. S.; Sun, Andrew; Hoheisel, Gerhard

doi:10.1136/pgmj.66.780.822

Cited by 36 publications

(29 citation statements)

References 15 publications

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“…This complication develops in 60±95% of cases [4,5,8]. In contrast to the autopsy case [1] and the Japanese case [2], our patient did not show severe stricture after the treatment.…”

Section: Discussioncontrasting

confidence: 44%

Endobronchial tuberculosis with expectoration of tracheal cartilages

Woo

Son

et al. 2000

Eur Respir J

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A case of endotracheal tuberculosis with expectorations of the lateral one-third of the multiple tracheal cartilages is reported. Fibreoptic bronchoscopy revealed caseous materials and loosening of the tracheal cartilages. The patient expectorated cartilaginous material several times before and after fibreoptic bronchoscopy. In spite of the loss of tracheal cartilages, tracheal lumen was maintained with a mild airflow limitation. The remaining two-thirds of the tracheal cartilage rings seemed to be strong enough to support the tracheal lumen opening during the respiratory cycle. Endobronchial tuberculosis is listed as one of the serious complications of pulmonary tuberculosis. Expectoration of bronchial cartilage is extremely rare in endobronchial tuberculosis. Only three previously reported cases have been found [1±3]. Coughing up tracheal cartilages has not been reported before. Such a case is reported in this study. Case reportA 29 yr-old female, with a history of tuberculous lymphadenitis, presented with a severe barking cough and mild dyspnoea. She had noted cough, sputum and mild dyspnoea 2 months prior to visiting our hospital. She had taken some medications without improvement. She noted increasing dyspnoea in the supine position. On questioning, one day before the visit, she had expectorated three or four hard objects during coughing. On physical examination, her vital signs were stable. There was no wheezing or crackling sound during auscultation. Laboratory findings were within normal range. The sputum smear for acid-fast bacilli was positive. The chest radiograph showed faint fibro-streaky densities involving the left upper lobe. The forced vital capacity (FVC) was 2.32 L (63% of predicted), forced expiratory volume at 1 second (FEV1 ) 2.09 L (61% pred), peak inspiratory flow (PIF) 2 L . min -1 . On the flow volume curves, the inspiratory limb had a very flat appearance, which suggests the presence of upper airway obstructive lesions ( fig. 1).Bronchoscopy revealed deep ulcers and two projections of cartilage on the left side of the distal trachea ( fig. 2). Multiple, yellowish mucosal elevations were also noted in the distal trachea. The orifice of the left main bronchus was narrowed with caseous material. After the bronchoscopy, the patient expectorated two tracheal cartilages, which were the lateral one-third part of the tracheal cartilage ( fig. 3). After two weeks of treatment with antituberculosis drugs, the second bronchoscopy showed one small remaining tracheal cartilage with caseous material between the distal trachea and the orifice of the left main bronchus. The remaining small tracheal cartilage was removed by biopsy forceps. After treatment with antituberculosis drugs for 6 months and with corticosteroid for 1 month, the third bronchoscopy was performed. The last bronchoscopy was performed 2 yrs after the initial diagnosis. There were no significant differences between the two periods. The mucosal lesions of tuberculosis were completely healed. There was no progressive tracheal...

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“…This complication develops in 60±95% of cases [4,5,8]. In contrast to the autopsy case [1] and the Japanese case [2], our patient did not show severe stricture after the treatment.…”

Section: Discussioncontrasting

confidence: 44%

Endobronchial tuberculosis with expectoration of tracheal cartilages

Woo

Son

et al. 2000

Eur Respir J

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“…Foreign body aspiration is another situation that should be considered in the differential diagnosis of ET (3)(4)(5)(6)11). A patient with asthmatic symptoms, hilar lymph node enlargement and parenchymal infiltration on Thorax CT was biopsied from endobronchial nodular appearance similar to our finding which revealed ET (2).…”

Section: Discussionmentioning

confidence: 57%

“…Several reports declared that ET manifests as different presentations. Parenchymal infiltration, especially patchy alveolar type was the most prevalent radiologic finding whereas it can mimic malignancy with partial segmental collapse appearance or right middle lobe syndrome (1,(3)(4)(5)(6).…”

Section: Introductionmentioning

confidence: 99%

Endobronchial tuberculosis mimicking lymphoma

Uyar¹,

Mete²,

Filiz³

et al. 2011

Gaziantep Med J

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Endobronchial tuberculosis may present with different clinical pictures. We presented a 55 year old patient with complaint of cough. She had palpable supraclavicular and cervical lymph nodes. Thorax CT revealed multiple conglomerated mediastinal lymph nodes. Multiple swollen mucosal nodularities were observed on bilateral endobronchial area during fiberoptic bronchoscopy. Although acidfast bacilli were negative in bronchial lavage fluid, biopsies obtained from the endobronchial nodules revealed caseous granulomatous inflammation compatible with tuberculosis. Improvement was achieved one month following antituberculosis therapy. This case report shows the importance of fiberoptic bronchoscopy in the differential diagnosis of subjects present with multiple mediastinal lymphadenopathies especially in populations where incidence of tuberculosis is high. Keywords: Bronchoscopy; lymphoma; tuberculosis Özet Endobronşial tuberküloz farklı klinik tablolarda karşımıza çıkabilir. Biz bu yazıda öksürük şikayeti olan 55 yaşındaki bir kadın hastayı sunduk. Hastanın palpe edilebilen supraklaviküler ve servikal lenf nodları mevcuttu. Toraks BT'de multipl konglomere mediastinal lenf nodları mevcuttu. Fiberoptik bronkoskopik incelemede ise yaygın mukozadan kabarık mukozal nodülariteler her iki akciğer alanlarında tespit edildi. Bronş lavajı ARB'si negatif olmasına rağmen endobronşial alandan alınan biyopsiler tüberküloza uyan şekilde kazeöz granulomatöz inflamasyonla uyumluydu. Tüberküloz tedavisi başlandıktan bir ay sonra düzelme tespit edildi. Bu olgu sunumu özellikle tüberküloz insidansının yüksek olduğu populasyonlarda multipl mediastinal lenfadenopatilerin ayırıcı tanısında fiberoptik bronkoskopinin önemini göstermektedir.

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“…4 EBTB, basil yükü fazla olan ve bronşiyal stenoz gibi morbiditesi yüksek komplikasyonlarla seyredebilen ağır bir durumdur. 9,10 Bu açıdan erken tanı konması ve vakit kaybedilmeden tedaviye başlanması gerekmektedir. Etkili antitü-berküloz tedavi ile enfeksiyon kontrolü sağlanabilmekte ama bronş stenozu büyük bir sorun olarak kalmaktadır.…”

Section: Discussionunclassified