|Year : 2013 | Volume
| Issue : 1 | Page : 35-36
Endobronchial tuberculosis simulating exacerbation of bronchial asthma
Department of Respiratory Medicine, Command Hospital, Lucknow, India
|Date of Web Publication||17-May-2013|
Chest Specialist and Trained in Critical Care, Command Hospital, Lucknow
Source of Support: None, Conflict of Interest: None
Despite extensive global efforts, pulmonary tuberculosis is still a major health problem worldwide. Endobronchial tuberculosis (EBTB) is seen in 10-40% of patients with active pulmonary tuberculosis. It commonly mimics the common lung diseases like bronchial asthma, pneumonia and lung cancer. Endobronchial stenosis is a common complication of EBTB. It requires early detection and prompt administration of anti-tuberculosis chemotherapy to prevent this complication. We are reporting an interesting case of a young male with bronchial asthma who presented with features of acute exacerbation and was diagnosed to have EBTB.
Keywords: Bronchial asthma, endobronchial tuberculosis, uncontrolled
|How to cite this article:|
Singhal S. Endobronchial tuberculosis simulating exacerbation of bronchial asthma. Sahel Med J 2013;16:35-6
| Introduction|| |
Endobronchial tuberculosis (EBTB) is defined as tuberculous infection of the tracheobronchial tree with microbiological or histopathological evidence. It simulates other lung conditions, leading to delayed diagnosis, as in our case.
| Case Report|| |
A 35-year-old male, a known case of bronchial asthma who had remained stable in the preceding 10 years on regular low-dose steroid inhaler (fluticasone 250 micrograms/day), was referred to us by his primary physician with a 6-month history of increased breathlessness associated with wheezing and cough and one episode of hemoptysis despite regular medication. He had received antibiotics, bronchodilator and short course of steroids without any improvement. He did not have any history of fever, anorexia, weight loss and hemoptysis. He denied any history of contact to a known tuberculosis patient, but he was a nursing attendant; therefore, contact with a tuberculosis patient could not be completely denied. Examination on admission revealed dyspneic and tachypneic patient with bilateral ronchi on auscultation. Hematological investigation revealed an erythrocyte sedimentation rate of 16 mm/h, hemoglobin of 14.2 gm/dL and total leukocyte count of 8200/cm 3 with eosinophil count of 12% (absolute eosinophil count: 960/cm 3 ). Biochemical investigation revealed fasting blood sugar of 85 mg/dL and post-prandial blood sugar of 116 mg/dL. Sputum for acid fast bacilli was negative on two consecutive days. Total serum IgE was 520 IU/mL (reference range 0-100 IU/mL).Aspergillus-specific IgG and IgE were negative. HIV serology was also negative. Chest radiograph revealed infiltrates in the right upper and middle zones [Figure 1].A computed tomography (CT) scan thorax revealed tree in bud appearance along with streaky opacities in the right upper lobe [Figure 2]. Bronchoscopy revealed extensive infiltration of the mucosa of the whole trachea, right main bronchus and right upper lobe. Bronchoalveolar lavage (BAL) fluid analysis was negative for malignant cell and acid fast bacilli. BAL fluid culture for Mycobacterium tuberculosis was positive. He was managed with 6 months of anti-tuberculosis drug (2R600H300E1000Z1500 + R600H300), with significant resolution after 2 months.
|Figure 1: Chest X-ray showing infi ltrates in the right upper and middle zones|
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|Figure 2: Computed tomography of the thorax showing tree in bud appearance along with streaky opacities in the right upper lobe|
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| Discussion|| |
EBTB is defined as tuberculous infection of the tracheobronchial tree with microbiological or histopathological evidence. It is often mistaken for bronchial asthma, lung cancer and other lung disease because of overlapping clinical and radiological features. , EBTB complicating bronchial asthma is very rare.  Worsening of wheeze and dyspnea may be due to the hypersensitivity reaction to the released tuberculosis antigens, as in our case. EBTB may exist without significant parenchymal abnormalities, and 10-20% patients may have normal chest radiograph.  Bronchoscopic EBTB have been classified into seven types: actively caseating (most common, as in our case), followed by edematous-hyperemic, fibrostenotic, tumorous, granular, ulcerative and non-specific bronchitis. ,
In conclusion, this case report is a reminder that EBTB is a diagnosis that may mimic other conditions like bronchial asthma and malignancy. Bronchoscopic examination and adequate sampling for Mycobacterium tuberculosis culture would enable the diagnosis to be made.
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[Figure 1], [Figure 2]