Tuberculous Lymphadenitis of Hilar Lymph Nodes as a Cause of Right Middle Lobe Syndrome: A Case Report

Abstract

Right middle lobe syndrome (RMLS) is a rare but important clinical entity that is characterized by recurrent or chronic collapse of the middle lobe of the right lung, but which may also involve the lingula of the left lung. In this case report, a 52-year-old female presented with typical constitutional symptoms of tropical disease like cough, fever, and shortness of breath. Chest radiology documented RMLS and bronchoscopy was key to the evaluation of this case, as a sputum examination was inconclusive. Transbronchial needle aspiration (TBNA) of the lymph node and bronchoalveolar lavage (BAL) specimens were tested and Mycobacterium tuberculosis (MTB) of the hilar lymph nodes on the right side was confirmed using the GeneXpert MTB/RIF assay. Four antituberculosis treatment drugs were initiated and maintained for a total of 8 months with steroids as an adjunct in tapering dosages for 4 weeks. Complete clinical and radiological recovery was documented and confirmed bronchoscopically. A high index of suspicion is important when managing RMLS cases and all possible measures should be taken to confirm diagnosis.

Progressive Primary Pulmonary Tuberculosis in Current Times: Are we really heading Towards ‘End of TB’ or Still, Many Miles to go for ‘Dream Come True’?

“…TB is one of the leading causes of mortality in India, killing two persons every 3 min, nearly 1000 every day [1]. Pulmonary tuberculosis can have diverse Ca s e R epo rt presentations ranging from cavitation, consolidation, tumorous lesions, lower lung filed tuberculosis and endobronchial and miliary nodules [2][3][4][5][6][7][8][9][10][11][12]. Similarly, non-tuberculous pathologies can present with abnormalities such as consolidations, nodules, cavitations mimicking tuberculosis [2][3][4][5][6][7][8][9][10][11][12][13][14].…”

“…Pulmonary tuberculosis can have diverse Ca s e R epo rt presentations ranging from cavitation, consolidation, tumorous lesions, lower lung filed tuberculosis and endobronchial and miliary nodules [2][3][4][5][6][7][8][9][10][11][12]. Similarly, non-tuberculous pathologies can present with abnormalities such as consolidations, nodules, cavitations mimicking tuberculosis [2][3][4][5][6][7][8][9][10][11][12][13][14]. Bronchoscopy is a very crucial interventional pulmonology technique in evaluating these cases [2][3][4][5][6][7][8][9][10][11][12][13][14].…”

“…Similarly, non-tuberculous pathologies can present with abnormalities such as consolidations, nodules, cavitations mimicking tuberculosis [2][3][4][5][6][7][8][9][10][11][12][13][14]. Bronchoscopy is a very crucial interventional pulmonology technique in evaluating these cases [2][3][4][5][6][7][8][9][10][11][12][13][14]. High risk factors for tuberculosis would be advanced age, malnutrition, pregnancy, steroids exposure, diabetes mellitus and immunosuppression [9][10][11][12][13][14].…”

“…Bronchoscopy is a very crucial interventional pulmonology technique in evaluating these cases [2][3][4][5][6][7][8][9][10][11][12][13][14]. High risk factors for tuberculosis would be advanced age, malnutrition, pregnancy, steroids exposure, diabetes mellitus and immunosuppression [9][10][11][12][13][14]. Tuberculosis in advanced stage may cause cardiac dysfunction and systemic effects which will have poor outcome if timely treatment not received [15][16][17].…”

Recurrent Pleural Effusion in Drug Sensitive Extrapulmonary Tuberculosis: Marker of Immune Dysregulation!

“…Pulmonary tuberculosis can have diverse presentations ranging from cavitation, consolidation, tumorous lesions, coin lesions, lower lung filed tuberculosis and endobronchial and miliary nodules [2][3][4][5][6][7][8][9][10][11][12]. Similarly, non-tuberculous pathologies can present with abnormalities such as consolidations, nodules, cavitations mimicking tuberculosis [2][3][4][5][6][7][8][9][10][11][12][13][14]. Bronchoscopy is a very crucial interventional pulmonology technique in evaluating these cases [2][3][4][5][6][7][8][9][10][11][12][13][14].…”